Results Of Medical Examinations Research Articles

Feasibility of using flow cytometry based on the analysis of changes in the general blood analysis of patients with COVID-19

Introduction. The pandemic of the coronavirus disease conditions the search for more significant clinical and laboratory manifestations of the disease and its complications, which can be achieved through the widespread introduction into clinical practice of modern methods of laboratory diagnostics. Aim: to determine the feasibility of using flow cytometry based on the analysis of changes in the general blood analysis of patients with COVID-19. Materials and methods. The results of leukocyte count indicators in the general blood analysis of 20 aged medical workers (55.3±2.4 years old) with COVID-19, who, according to the results of previous medical examinations, did not have chronic blood diseases, were considered. In the study, only the data of the general blood test during hospitalization before the start of treatment were taken into account. Research results and their discussion. When analyzing changes in the general blood test in patients with a similar clinical course of COVID-19, the authors demonstrated typical changes in individual indicators of the leukocyte count and the leukocyte formula in general. In 20 patients with COVID-19-associated pneumonia confirmed clinically by chest computed tomography and real-time polymerase chain reaction, visible changes in the white blood cell count were mostly absent or of a nature that did not allow to correlate them with typical leukocyte reaction in viral infection. The data of the complete blood count did not have reliable correlations with the clinic, other laboratory indicators and the results of treatment. Conclusions. In 25% of cases of patients with COVID-19, there are no changes in the leukocyte formula specific to a viral infection, and in another 50% of cases, changes in the content of leukocytes are of an undefined nature. The weak correlation between the indicators of the blood leukocyte series and the patient’s clinical condition indicates a limited possibility of reliable interpretation of the results of general clinical examination methods. The introduction of flow cytometry to control blood changes in patients with coronavirus infection is the most promising and expedient step for solving the existing problems of laboratory diagnostics.

Disputable issues of application of the medical criterion «persistent loss of general work capability» in determining the severity of harm caused to human health

The purpose of the work is to identify challenging issues that arise during the forensic determination of the severity of harm caused to human health, which entailed permanent loss of general ability to work, by means of a content analysis of the existing regulatory documents, results of forensic medical examinations and the formulation of proposals for their modification and supplementing with regard to elimination of existing contradictions. The analysis of expert practice on a selective study of 1.000 expert conclusions for 2016-2022 is given, which showed that, when assessing the severity of harm caused to human health in a number of cases (3.3%) in identical situations, various options for establishing harm caused to human health are possible depending on its severity. The conclusion was made that the requirement specified in the clause 6.11 of the Medical Criteria for Determining the Severity of Harm Caused to Human Health (approved by the Order of the Ministry of Public Health and Social Development of the Russian Federation No. 194H dated April 24, 2008, Moscow) to determining serious harm as causing persistent loss of general work capability by not less than one third, regardless of the outcome, in all cases listed in paragraphs 6.11.1-6.11.9, cannot be unconditionally applied in expert practice.

Features of damage to the body parts in bicycle riders when falling from moving bicycles

The study objective is to analyze the results of forensic medical examination (FME) of fatal cases of falling off a bicycle (9 cases) and a similar non-fatal injury (18 cases). All cases were males aged 8 to 74 years. Of the 27 cases, 6 were children aged 8-17 years. Head and chest injuries were the most common. The nature and localization of these injuries, along with strip-like, linear and parallel abrasions on the skin of the anterolateral surface of the body, indicated that they were a result of collisions and slips of the victim's body on the road surface. A few cases of penetrating injury of the abdomen with internal organs damage were observed; they were related to the impact of the handlebars and were the most characteristic of this type of injury. The data presented may help distinguish the fall of bicycle riders from other types of accidents, in particular from collisions between moving vehicles and pedestrians. The nature of the identified injuries can be considered when providing medical care to the victims.

Experience in using the results of periodic medical examinations to assess the risk of developing diseases of the circulatory system

<h3></h3> Здоровье работающего населения в Российской Федерации многие годы вызывает озабоченность специалистов в сфере медицины труда и общественного здоровья. Особого внимания заслуживает изучение показателей здоровья и управление риском развития хронических неинфекционных заболеваний в первую очередь болезней системы кровообращения у работников, занятых во вредных и (или) опасных условиях труда. <h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Оценить возможность использования результатов периодических медицинских осмотров работников, занятых во вредных и (или) опасных условиях труда, для оценки риска развития болезней системы кровообращения. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Сплошным методом исследованы медицинские карты работников крупного металлургического предприятия Свердловской области. В выборку включены 1162 работника конвертерного цеха. Использованы опросники и объективные показатели, проведена оценка метаболических нарушений. Степень связи между показателями оценивали по отношению шансов. Для статистической обработки данных использована программа SPSS 17, применен непараметрический метод Манна—Уитни. <h3>РЕЗУЛЬТАТЫ</h3> У 83,5% работников диагностированы заболевания эндокринной системы, расстройства питания и нарушения обмена веществ, у 30,2% — болезни системы кровообращения. Избыточную массу тела имеют 67,3% рабочих. Метаболически нездоровый фенотип выявлен в 18,6% наблюдений. Повышенный уровень артериального давления ассоциирован с высокими показателями общего холестерина, увеличенной окружностью талии, ожирением, употреблением алкоголя, а повышение уровня общего холестерина — с ожирением. Установлен суммарный сердечно-сосудистый риск у 68,8% работников от умеренного (61,1%) до очень высокого (1,1%). <h3>ЗАКЛЮЧЕНИЕ</h3> Результаты периодических медицинских осмотров могут и должны быть использованы субъектами предпринимательской деятельности для определения приоритетных направлений при разработке и реализации корпоративных программ укрепления здоровья работающих при взаимодействии с органами и учреждениями системы Роспотребнадзора, региональными центрами профпатологии, иными специалистами в сфере медицины труда.

Health and Mortality in Korean Healthcare Workers.

BackgroundTo evaluate the health status of healthcare workers (doctors and nurses) compared to those in the general population based on the National Health Insurance Service database and the cause of death data from Statistics Korea.MethodsThe subjects of this study were 104,484 doctors and 220,310 nurses working in healthcare facilities from 2002 to 2017, and who had undergone at least one general medical examination. Based on the subject definition, the subject data were extracted from the National Health Insurance healthcare facility database and qualification database. We collected medical use details included in the research database, general medical examination results, medical history included in the health examination database, and additional data on the cause of death from the National Statistics database to analyze the main cause of death and mortality.ResultsIn terms of the major causes of death and mortality among healthcare workers, the mortality rate associated with intentional self-harm, injury, transportation accident, heart disease, addiction, and falling was significantly higher than that in the general population. Further, the prevalence of respiratory and gastrointestinal diseases was high. When analyzing the proportional mortality ratio (PMR) by cause of death for healthcare workers, the PMR values for death related to malignant neoplasm was the highest. In terms of diseases, both doctors and nurses had higher rates of infectious diseases such as maternal sepsis, rubella, and measles.ConclusionThe health status of healthcare workers differs from that of the general population. Thus, it is important to consider the occupational characteristics of healthcare personnel. This study is unique in that it was conducted based on medical use indicators rather than survey data.

Oxidative stress in suyagny sheep at the end of gestation, as a factor in pathogenesis development of eclampsia

Analysis of the results of medical examination of pregnant sheep 30...15...5 days before the expected term of lambing showed that in the urine of 12.11% of ewes, the concentration of ketone bodies in the blood plasma was 1.43 times higher than the physiological norm. In addition, there is a tendency to decrease the buffer bases to 18.41±1.53 mmol/l, as well as the glucose content below 2.12 ± 0.12 mmol/l. At the same time, the ratio of VN/ ACAS is up to 1.47 ± 0.12 mmol / L. It was found that the albumin fraction of proteins decreased by 1.51 times. Edema in the abdominal wall and underbelly, 9.5% lack of reaction to external stimuli, 15.0% decreased appetite, 10.0% jaundice of mucous membranes and 9.0% of sheep had a comatose state were found in 15.0% of animals. In a clinical study in sheep with eclampsia, hypertension over 136.1 mmHg and the presence of protein in urine over 3.2 g/l were recorded. These symptoms indicated classic signs of eclampsia, which occurred depending on the condition of sick animals in atypical and typical forms of manifestation. In animals with typical clinical signs of eclampsia, an increase in the level of diene conjugates was found to be 1.87 times, and the concentration of ketodiene intermediates and conjugated trienes was 1.75 times, the concentration of stable nitric oxide metabolites was 38.0%, and the vitamin E content decreased by 13.1%. At the same time, there was a 20.46% increase in the concentration of double bonds in the atypical form of eclampsia. In the blood plasma of patients with eclampsia of pregnant ewes, the activity of superoxide dismutase (1,736±0.37 units) is lower than in the comparison group (2,146±0.56 mmol/l). The obtained material of this work should be taken into account in the future when studying the problem of complicated pregnancy in the last stages of gestation in sheep and when developing therapeutic and preventive measures to ensure the long-term functioning of the reproductive potential and obtaining a viable newborn offspring.

The experience in studying the health status of liquidators to eliminate environmental pollution associated with the production of chemical products

Introduction. Maintaining health and achieving professional longevity is a priority task of medical support for specialists in the power and civil structures of Russia. It is especially important to take into account the impact of several factors of the labour process, as, for example, in the work to eliminate environmental pollution from enterprises producing chemical products, in particular, in the shop of mercury electrolysis. The study aims to explore the health status of employees of law enforcement agencies and civilian personnel involved in the elimination of environmental pollution in the city of Usolye-Sibirskoye, Irkutsk region as a result of economic activities associated with the production of chemical products. Material and methods. The study examined 370 people, whose average age was 28.4±5.5 years, with an average work experience of 6.0±1.05 years. The method of clinical observations was used, the analysis of the results of an in-depth medical examination was carried out in the conditions of the professional center of the clinic of the Federal State Budgetary Scientific Institution VSIMEI. The level and structure of morbidity by the main classes of chronic diseases have been studied. Results. As a result of the analysis of the data of the periodic medical examination, the structural composition of nosological forms of diseases was presented as follows: diseases of the cardiovascular system - 10%, ophthalmological diseases - 5%, endocrinological diseases - 5%, diseases of ENT organs - 10%, practically healthy persons - 70%. The mercury levels were determined at zero values, with the exception of 4 samples, in which the mercury content in the studied urine samples did not exceed the permissible level established by WHO (10 μg / L), the mercury levels in hair samples did not exceed the biologically permissible level (0.0-2,0 μg/g). Conclusion. This study showed the importance of medical examinations using extended examination methods and the need to monitor the health status of liquidators, since the safety of the work carried out also depends on the quality of workers' health.

АЛГОРИТМ ОБЕСПЕЧЕНИЯ ЗАЩИТЫ КОНФИДЕНЦИАЛЬНЫХ ДАННЫХ ОБЛАЧНОЙ МЕДИЦИНСКОЙ ИНФОРМАЦИОННОЙ СИСТЕМЫ

The aim of the work is the development and implementation of the architecture of a cloudstorage system, systematization and processing of survey results (for example, EEG) and an algorithmfor ensuring the protection of confidential data based on a completely homomorphic cryptosystem.The object of the research is the technologies of storage, transmission, processing andprotection of confidential information in distributed medical information systems. The architectureof a cloud platform for distributed storage, processing, systematization and protection of confidentialdata (results of medical examinations) has been developed, which makes it possible to interactwith various medical information systems and diagnostic hardware in order to generate big data.An algorithm has been developed to ensure the safety of medical data stored in a cloud platform in electronic form, recorded during patient examinations in order to calculate the average value foreach of the brain activity rhythms (based on the results of a series of examinations over a longperiod of time) using a fully homomorphic encryption algorithm. Based on the test results (analysisof the execution time of such operations as: encryption, decryption, addition, multiplication,signal-to-noise ratio of ciphertext to plaintext), the optimal algorithm. According to the results ofthe work, it is shown that the fully homomorphic encryption scheme CKKS is the most effective,especially in the context of the criticality of the requirements for a high level of security of confidentialdata, which determines the choice of this scheme for the implementation of the algorithmproposed in this work.

Гигиеническая оценка факторов риска и состояние здоровья судебномедицинских экспертов

The objective of the study was to develop and implement the system of hygienic measures eliminating (mitigating) the impact of risk factors in the work of forensic scientists and to estimate effectiveness of these measures and the program aimed at improvement of employment terms for forensic scientists [1, 2]. Forensic scientists were compared to a control group of other doctors. The following researches were carried out: survey of 303 forensic scientists, analysis of their employment terms based on employment terms special evaluation (2,736 materials of employment terms special evaluation), examination of forensic scientists’ health compared to other doctors by analyzing medical examination results (309 health records). Protection and promotion of working population’s health is the state priority. Its purpose is to preserve labor potential and create conditions for economic development of the country. Medical workers are exposed to a combined, complex, and associated effect of working environment conditions and parameters [3, 4]. Industrial and social factors can result in a rising incidence, reduction in life expectancy, ill health and medical staff performance increment, and require preventive measures. Those working for forensic expert organizations constitute a special population due to a large number of professional, medical and organizational, and social risk factors [5].

Prevalence of risk factors for non-communicable diseases among the adult population of several administrative districts of Moscow before the COVID-19 pandemic

Introduction. Currently, increased attention of public policy is paid to non-communicable diseases, which are the leading causes in the structure of mortality, disability and morbidity of the population. In this connection, many government programs are currently being implemented to prevent non-communicable diseases and correct risk factors. Finland's experience in the implementation of the North Karelia project has shown the effectiveness of the prevention of noncommunicable diseases through interagency cooperation. As a result, one of the priority areas of work of the Ministry of Health of the Russian Federation has become the formation of a unified system of strengthening public health. In 2020, the Moscow Department of Health approved the Regional Program for Strengthening the Public Health of the Moscow Population, on the basis of which district programs began to be developed. Objective. Analysis of the prevalence of risk factors for non-communicable diseases among the adult population of the Northern, North-Eastern and Southern administrative districts for 2017–2019. Materials and methods. The materials used were programs to strengthen the public health of the population of the Northern Administrative District, Northern Eastern Administrative District and the Southern Administrative District of Moscow. Results. The largest number of pathological abnormalities in the course of a preventive medical examination and clinical examination is revealed during a survey (questionnaire) and examination by a general practitioner, i. e. at the beginning and at the end of the first stage of clinical examination. According to the results of preventive medical examinations and clinical examination, the greatest contribution (more than 50 %) is made by such risk factors as inappropriate nutrition, low physical activity and overweight, the smallest proportion was hyperglycemia (from 1.2 % to 2.9 %). A high percentage of identified risk factors for non-communicable diseases is noted in the age group 39–60 years old (mainly among women), about 40 % – in the elderly population (over 60 years old).

Retinal arterial macroaneurysm in a patient with arterial hypertension

Purpose: To present a case of retinal arterial macroaneurysm in a 48–year–old male patient with systemic arterial hypertension.&#x0D; Case report: A 48–year–old male was admitted to our department because of progressive deterioration of visual acuity in his right eye. He reported diplopia and blurred central field vision. The patient was treated for systemic arterial hypertension and had no other known medical problems. Medical treatment, examination results, and therapy were presented in this case report.&#x0D; Conclusions: In the treatment of patients with retinal arterial macroaneurysm a holistic approach is important. In an attempt to optimize the final outcome of the patient's treatment, both the ocular symptoms and systemic risk factors should be treated. Therapeutic interventions for eyes with retinal arterial macroaneurysm include laser photocoagulation, pneumatic displacement of haemorrhage, vitreoretinal surgical techniques, the use of neodymium–doped yttrium aluminium garnet or argon laser, and intravitreal injections of anti–vascular endothelial growth factor drugs. Their precise roles should be evaluated in further studies.

Xanthogranulomatous Cholecystitis: Our Clinical Experience

Background: Xanthogranulomatous cholecystitis is a rarely encountered chronic inflammatory condition presenting with severely proliferated fibrotic tissue. It usually spreads the neighboring organs, imitates gallbladder cancer and may lead to difficulty in cholecystectomy. Objectives: The present study was directed towards reviewing the results of medical examinations and surgery for xan-thogranulomatous cholecystitis and providing proper surgical treatment for patients with xanthogranulomatous cholecystitis. Methods: This is an observational study in which clinical features of thirty six patients with diagnosis of cholecystitis who were operated in our institute between 2012 and 2019 and found as xanthogranulomatous cholecystitis on pathology were analyzed. Results: The rate of xanthogranulomatous cholecystitis in cholecystectomy patients was found to be 0.6 % (36/5999) in the hospital where this study was performed over 7 years. Xanthogranu-lomatous cholecystitis was not accompanied by gallbladder carcinoma in any of these cases. Xanthogranulomatous cholecystitis could not be diagnosed in any of the patients prior to surgery. Radiological imaging performed before surgery demonstrated cholelithiasis in 29 patients (80.6 %), thickening of the gallbladder wall in 28 patients (77.8%), and suspicious cancer in two patients (5.6%). However, none of the cases of xanthogranulomatous cholecystitis had concomitant gallbladder cancer. Nine (25%) patients underwent open cholecystectomy and Twenty seven patients (75 %) were scheduled to have laparoscopic cholecystectomy, but six of these patients (16,8%) were converted to open cholecystectomy. Conclusion: To conclude, it is still difficult to distinguish xanthogranulomatous cholecystitis from other gallbladder diseases both before and during surgery. The gallbladder commonly adheres to the neighboring organs and tissues and make surgical treatment difficult. A challenging laparoscopy is commonly converted to open surgery, which results in higher rates of complications as compared with standard open or laparoscopic cholecystectomy.

The morbidity of medical personnel of mobile teams of emergency medical care

The medical personnel of mobile teams of emergency medical care are exposed to factors of working environment that affect health state and results in development of occupational diseases. The purpose of study is to analyze morbidity of medical personnel of mobile teams of emergency medical care according data of temporary disability and results of medical check-ups. The analysis was made according information from certificates of incapacity for work and the final acts of periodic medical examinations for five-year period. The study established significant increase of rate and duration of primary and general morbidity with increase of age and length of service of workers, higher susceptibility to diseases of physicians as compared with paramedics and employees of pediatric teams and specialists of other clinical profiles. In the structure of morbidity according to results of medical examinations, diseases of the eye and its accessory apparatus, the circulatory system and the musculo-skeletal system prevailed.

Diabetes severity measured by treatment control status and number of anti-diabetic drugs affects presenteeism among workers with type 2 diabetes

BackgroundThe number of people with diabetes is increasing and resulting in major economic losses. Presenteeism accounts for the majority of economic losses, so measures against presenteeism are important. This study investigated the relationship between severity of type 2 diabetes and presenteeism.MethodsA cross-sectional study was conducted among workers over 40 years of age. Participants were classified as normal group or diabetic treatment group using their medical examination results and health insurance claims data. Diabetic treatment groups were described by degree of treatment control: Good (HbA1c < 7%), Intermediate (7% ≤ HbA1c < 8%), and Poor (8% ≤ HbA1c). Therapy type was also divided into monotherapy and combination therapy. Logistic regression analysis was performed to predict presenteeism loss using the Quantity and Quality method.ResultsData on 13,271 workers were analyzed. Presenteeism loss was significantly higher in all treatment control groups compared with the normal group, particularly for the intermediate and poor control groups. The monotherapy group did not differ from the normal group, but presenteeism loss was significantly higher in the combination therapy group than the normal group.ConclusionsPresenteeism loss in workers with diabetes may be affected by diabetes severity, and even if treatment control were good, presenteeism loss could occur when the number of anti-diabetic drugs was high. Therefore, it is important to provide early intervention and continuous support as a preventive measure against not only diabetes and diabetes-related complications but also presenteeism.

Analysis of the prevalence, intensity and features of the clinical course of caries in early childhood and preschool children based on the data of preventive medical examinations

Aim. To study the prevalence, intensity and features of the clinical course of caries in children from 1 to 5 years old, to improve the registration of dental morbidity.Materials and methods. An epidemiological and clinical examination of the child population was carried out as part of preventive medical examinations of minors. The study involved 1930 children from Moscow, aged from 1 to 5 years. The epidemiological survey was carried out to study the dental morbidity in children of early childhood and preschool age. Clinical research methods were carried out to determine the dental status of the subjects. All studies in children were performed with informed voluntary consent. Parents or legal representatives signed their consent to the survey. Results. Analysis of the results of preventive medical examinations of minors made it possible to determine the prevalence, intensity and characteristics of the clinical course of caries in the period of early childhood (preschool period) and preschool age among the children's population of Moscow.Conclusions. It was found that the prevalence and intensity indicators increase as children grow up, the depth of the lesion and the localization of carious lesions change at different age periods.

The role of preventive medical examinations in obligatory clinical check-ups of children in Azerbaijan

In 2014, obligatory medical check-ups of the child population were legislatively introduced in Azerbaijan. At the same time, for the early detection of diseases and various pathological conditions, health services of the country paid special attention to precisely preventive measures which will predetermine both the state of child health, as well as the quality of their life in the future.In order to increase the efficiency of obligatory medical check-ups, the morbidity rates of the child population of Azerbaijan were analyzed based on the results of preventive medical examinations for the period 2014—2019.

Automatic Classification of Thyroid Findings Using Static and Contextualized Ensemble Natural Language Processing Systems: Development Study.

BackgroundIn the case of Korean institutions and enterprises that collect nonstandardized and nonunified formats of electronic medical examination results from multiple medical institutions, a group of experienced nurses who can understand the results and related contexts initially classified the reports manually. The classification guidelines were established by years of workers’ clinical experiences and there were attempts to automate the classification work. However, there have been problems in which rule-based algorithms or human labor–intensive efforts can be time-consuming or limited owing to high potential errors. We investigated natural language processing (NLP) architectures and proposed ensemble models to create automated classifiers.ObjectiveThis study aimed to develop practical deep learning models with electronic medical records from 284 health care institutions and open-source corpus data sets for automatically classifying 3 thyroid conditions: healthy, caution required, and critical. The primary goal is to increase the overall accuracy of the classification, yet there are practical and industrial needs to correctly predict healthy (negative) thyroid condition data, which are mostly medical examination results, and minimize false-negative rates under the prediction of healthy thyroid conditions.MethodsThe data sets included thyroid and comprehensive medical examination reports. The textual data are not only documented in fully complete sentences but also written in lists of words or phrases. Therefore, we propose static and contextualized ensemble NLP network (SCENT) systems to successfully reflect static and contextual information and handle incomplete sentences. We prepared each convolution neural network (CNN)-, long short-term memory (LSTM)-, and efficiently learning an encoder that classifies token replacements accurately (ELECTRA)-based ensemble model by training or fine-tuning them multiple times. Through comprehensive experiments, we propose 2 versions of ensemble models, SCENT-v1 and SCENT-v2, with the single-architecture–based CNN, LSTM, and ELECTRA ensemble models for the best classification performance and practical use, respectively. SCENT-v1 is an ensemble of CNN and ELECTRA ensemble models, and SCENT-v2 is a hierarchical ensemble of CNN, LSTM, and ELECTRA ensemble models. SCENT-v2 first classifies the 3 labels using an ELECTRA ensemble model and then reclassifies them using an ensemble model of CNN and LSTM if the ELECTRA ensemble model predicted them as “healthy” labels.ResultsSCENT-v1 outperformed all the suggested models, with the highest F1 score (92.56%). SCENT-v2 had the second-highest recall value (94.44%) and the fewest misclassifications for caution-required thyroid condition while maintaining 0 classification error for the critical thyroid condition under the prediction of the healthy thyroid condition.ConclusionsThe proposed SCENT demonstrates good classification performance despite the unique characteristics of the Korean language and problems of data lack and imbalance, especially for the extremely low amount of critical condition data. The result of SCENT-v1 indicates that different perspectives of static and contextual input token representations can enhance classification performance. SCENT-v2 has a strong impact on the prediction of healthy thyroid conditions.

Стан здоров’я юних спортсменів — вихованців училища фізичної культури

Актуальність. Стан здоров’я юних спортсменів — вихованців училища фізичної культури залишається невивченим. Мета дослідження — порівняльна оцінка стану здоров’я юних спортсменів залежно від віку, статі та виду спорту. Матеріали та методи. Вивчено стан здоров’я 499 вихованців училища фізичної культури (330 хлопців і 169 дівчат) віком 12–19 років — представників 14 видів спорту за результатами медичних оглядів і записів у картах диспансерного спостереження. Результати. У 72 % учнів спостерігалися відхилення від норми показників електрокардіограми, у 65 % — соматичні та інфекційні захворювання, у 48 % — патологія опорно-рухового апарату, у 35 % — травми, 14 % учнів пред’являли скарги на стан здоров’я, частота яких, як правило, залежала від їх віку та статі. Специфіка виду спорту суттєво впливала на частоту відхилень на електрокардіограмі, менш істотно — на частоту патології опорно-рухового апарату, травм і майже не впливала на частоту інших соматичних та інфекційних захворювань. Висновки. Більша частота відхилень на електрокардіограмі, захворювань і травм реєструється в представників циклічних, технічних видів спорту, боротьби та п’ятиборства.

The healthy/unhealthy worker effect as a phenomenon of occupational selection and the causation problem

Today, the "healthy worker effect" is understood as organized (on the part of the employer) and/or unorganized (self-selection on the part of the worker, due to the functional capabilities and the state of workers’ health) professional selection of healthier workers in unfavorable working conditions, who remain in the profession. It represents one of the most important problems in epidemiological research in occupational medicine. The “healthy worker effect” and its intensity in various industries (in various professions) can indirectly characterize the harmful and unfavorable conditions. The “healthy worker effect” and its intensity determine the need for medical and social security, as well as rehabilitation measures, not only for people who remain in this production (in this profession), but also for people who left this production or specialty, to prevent the phenomenon of increased mortality among workers who left a given production or profession due to suspension from work based on the results of periodic medical examinations and self-selection, or due to intolerance to working conditions because of the state of health.

Occupational Health Risks from Combined Exposure to Welding Fumes and Cold Environment for Welders

Introduction: Intensification of economic activities in the northern regions of Russia requires a better understanding of the combined health effect of cold environment and occupational risk factors. Objective: To assess the risk of developing health disorders in gas and electric welders exposed to low and normal workplace temperatures. Materials and methods: We conducted a comparative analysis of working conditions and health status of welders at two enterprises. The main cohort included 310 workers exposed to welding fumes and cold microclimate in an underground mine. The control cohort included 282 employees of a railcar manufacturing facility performing their functional duties in workshops with acceptable microclimate parameters. Results: According to the results of periodic medical examinations, 499 chronic diseases were diagnosed in welders of the main cohort against 230 among the controls. Compared to the reference cohort, underground welders were at higher risk of developing diseases of the digestive system (RR = 2.63; CI: 1.47–4.70; p = 0.0006), genitourinary (RR = 6.55; CI: 1.51–28.4; p = 0.004), musculoskeletal (RR = 1.50; CI: 1.14–1.97; p = 0.003), and nervous systems (RR = 5.29; CI 1.19–23.4; p = 0.014), skin (RR = 3.85; CI: 1.61–9.18; p = 0.001), respiratory organs (RR = 3.23; CI: 1.84–5.69; p &lt; 0.001), as well as infectious and parasitic diseases (RR = 8.61; CI: 2.03–36.5; p = 0.0004). Thus, the number of healthy workers was smaller while the number of workers suffering from two or more chronic diseases was bigger in this cohort (p &lt; 0.001). Conclusions: The welders working in cold environment were significantly less healthy than those working in normal workplace temperatures. The results necessitate the development of additional measures of disease prevention for this category of employees.