Any field of activity has its own problems and ailments that are characteristic of certain specialties. Occupational diseases of medical workers are a special issue. Many do not even suspect that representatives of this profession put themselves at risk every day when dealing with pathologies of varying severity, pathogenic bacteria and electromagnetic devices. A combination of factors can provoke the development of irreversible changes in the body, which are considered to be occupational diseases.
Finding himself in such a situation, a healthcare worker becomes entitled to receive benefits and subsidies. However, not everyone has an idea where to go and what types of support they can count on.
Definition of occupational diseases. Legal side of the issue
There are two types of occupational diseases: acute and chronic. In the first case, we are talking about a short-term ailment that manifests itself during the working day. The causes of this pathology can be the influence of any external factors, for example, intoxication of the body, provoked by the action of a toxic substance.
In the second case, we are talking about long-term exposure, as a result of which, harmful factors accumulate in the body, becoming chronic. Depending on the type of pathology, the amounts of compensation vary: one-time payments, monthly benefits and packages of intangible benefits.
To resolve these issues, a number of legislative acts are provided. For example, the federal law No. 125 of July 24, 1998:
- Article 5: list of persons for whom social insurance against accidents and occupational diseases is mandatory;
- Articles 11 and 12: amount of insurance payments.
In addition, this includes:
- Federal Law No. 323 of November 21, 2011: fundamentals of protecting the health of citizens of the Russian Federation.
- Article 350 of the Labor Code: features of regulation of the work of health workers.
- Government resolution of December 15, 2000: indexation of one-time and monthly payments.
- Order of the Ministry of Health No. 417 of April 27, 2012: list of occupational diseases.
Varieties and categories
- anesthesiologists;
- surgeons;
- radiologists;
- dentists;
- pathologists;
- infectious disease specialists;
- middle and junior level medical staff;
- pharmacists;
- laboratory assistants.
The risk group also includes employees of enterprises involved in the production of medicines and other medical products.
In general, occupational diseases of healthcare workers are divided into 4 categories (Order of the Ministry of Health and Social Development of Russia dated April 27, 2012 No. 417n):
- Chemical toxic poisoning. They appear as a result of prolonged interaction of the skin with dangerous chemicals: arsenic, camphor, iodine solution. May result in acute poisoning or severe intoxication of the body.
- Biodefeat. Illnesses manifest themselves as a result of constant contact with patients suffering from infectious diseases. The main pathologies of this group: HIV infection, tuberculosis, hepatitis.
- Physical and mechanical damage. Occupational diseases radiologists and medical personnel working with radiation equipment. Magnetic resonance and other radiation, with prolonged exposure, negatively affects the functioning of all organs and systems of the human body. Most affected: cardiovascular and central nervous systems.
- Physical inactivity. It occurs among specialists whose professional activities involve long periods of staying in one body position. Tissue atrophy may occur here lower limbs, problems with the spine and visual organs.
- damage to the nervous system;
- pathological changes in the spine;
- ailments of the upper respiratory tract, including bronchial asthma;
- conjunctivitis;
- connective tissue damage.
In fact, the characteristic features of all four categories are collected here. In addition, dental technicians may suffer from silicosis: a pathology that develops as a result of cement particles entering the oral cavity.
How to register an occupational disease
- notifying the management and representative of the supervisory organization that monitors the sanitary and epidemiological condition of the medical institution;
- within 24 hours, upon the employee’s request, an inspection must be carried out to ensure that the workplace complies with safe working conditions;
- Based on the results of the inspection, an act is drawn up, which is sent to a higher authority: the Ministry of Health, from where confirmation comes that the illness belongs to the category of occupational diseases;
- the employee receives a medical certificate confirming the fact of the occupational disease.
If an illness is detected, the employee may be transferred to another place of work, where exposure to the factors that led to the development of the pathology is excluded. If the symptoms go away, the person returns to his previous place.
Important! For medical workers who are faced with occupational illnesses, there are a number of restrictions on work activity. In particular, persons infected with hepatitis or HIV infection cannot work with medicines invasive action. Employees who have had tuberculosis are allowed to resume their previous professional duties after recovery. Exception: pediatricians and other personnel working with children.
Benefits and allowances
- one-time compensation for loss of ability to work (professional) - the employee retains workplace, but cannot perform previous duties;
- monthly benefits - calculated personally, depending on the severity of the illness, paid as a percentage of the official salary.
In addition, such employees are required to be provided with vouchers for sanatorium and resort treatment, if there is a medical need for this and the direction of a medical expert commission. Travel in both directions is paid.
Registration procedure
To receive benefits, an employee who has received an occupational disease must follow the following procedure:
- contact a general practitioner at your site, having in hand a document certifying the presence of an occupational illness;
- pass necessary tests, undergo examination by specialized doctors;
- after passing the medical examination, receive a referral for a medical and social examination;
- members of the commission, based on the doctors’ conclusions, confirm the disease and determine its severity;
- Having received the conclusion of the MES, the citizen must contact the social insurance department at the place of residence, collecting a package of documents necessary to receive benefits;
After this, the person is assigned benefits and material payments prescribed at the state level. Privileges are issued on the basis of:
- passports;
- conclusions
- Medical and social expert meeting">MES ;
- an act certifying the fact of an occupational disease;
- work book (photocopy);
- certificates of average salary.
An application for benefits is written at the place of application. It is better to do this in the presence of a social insurance employee to avoid errors when filling out.
Preventive actions
Today, there are two types of preventive measures aimed at preventing the development of occupational diseases among healthcare workers. They are conditionally divided:
- primary;
- secondary;
The first category includes theoretical events, which include lectures on this topic, mandatory training on compliance with safety precautions at work, and familiarization of employees with statistical data.
Secondary measures are more effective and include the following procedures:
- carrying out inspections at workplaces, purpose: monitoring compliance with personal hygiene, rules for working with hazardous substances, waste disposal;
- providing personnel with personal protective equipment;
- Conducting regular medical examinations to identify occupational illnesses initial stages development, preventing them from developing into the chronic phase.
The combination of such measures makes it possible to timely identify potentially dangerous factors and prevent the development of diseases.
Occupational health insurance:
All employed citizens Russian Federation, including healthcare workers, are entitled to compulsory social insurance. All contributions required in such cases are paid by the direct employer. If this moment is drawn up in accordance with the letter of the law, an employee who has received an occupational disease acquires the right to financial compensation for harm caused to health.
Compensation is expected in cases where a citizen applied to the Social Insurance Fund to obtain the appropriate certificate. Every employed citizen must have such certificates.
It is important to understand that many healthcare professions are exposed to the risk of infection every day through their contact with their patients. Therefore, the task of the state and departmental organizations is to reduce the likelihood of the occurrence of occupational diseases, and to provide comprehensive support to medical staff if workers are faced with this problem.
Among almost 40 thousand currently existing professions, more than 4 million medical workers occupy a special social niche. The work of doctors is one of the most complex and responsible types of human activity.
It is characterized by significant intellectual load, and in some cases – large physical activity and endurance. Medical workers are subject to increased demands, including the volume of operational and long-term memory, attention, and high ability to work in extreme conditions.
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That is why it remains in focus today.
The result of the activities of medical workers - the health of patients - is largely determined by the working conditions and health status of employees. By occupation, a doctor (as well as a nursing and junior medical worker, a pharmacist and a pharmacist) is affected by a complex of factors of a physical, chemical, and biological nature.
Doctors experience high neuro-emotional stress. In addition, in the process of professional activity, individual organs and systems of the body are subject to functional overstrain (from functional overstrain of the musculoskeletal system to overstrain of the organ of vision).
Prevention of occupational diseases among health workers
The works of academician are devoted to the analysis of the health status of medical workers. RAMS N.F. Izmerova, V.G. Artamonova, N.A. Mukhin, the first monograph in the Russian Federation by the Honored Scientist of the Russian Federation, Professor V.V. Kosarev “Occupational diseases of medical workers” (1998).
The results of a study of medical histories of medical workers who applied to the clinical expert commission of the Samara Regional Center for Occupational Pathology over the past 15 years (397 people: doctors, nurses, laboratory assistants, nurses), made it possible to identify the following etiological structure of occupational diseases:
Structure and full list occupational diseases of medical workers are enshrined in the order of the Ministry of Health and Medical Industry of Russia dated March 14, 1996 No. 90 “On the procedure for conducting preliminary and periodic medical examinations of workers and “.
Prevention of occupational diseases: allergies
Allergic reactions to natural latex dust are high among medical workers. According to E.V. Makova (2003), the prevalence of latex allergy is 22.61%.
Clinically, latex allergy in medical workers in 32.5% of cases occurs as an immediate type of hypersensitivity and is manifested by bronchial asthma, allergic rhinitis, urticaria, including in 6% of cases - acute allergic reactions (Quincke's edema, anaphylactic shock), requiring providing emergency medical care.
In 67.5% of cases, allergic reactions upon contact with natural latex occur as delayed-type hypersensitivity and manifest themselves as contact dermatitis.
The most severe and prognostically unfavorable is anaphylactic shock - allergic reaction immediate type.
It is characterized by rapidly developing predominantly general manifestations: decreased blood pressure, body temperature, central nervous system disorder, increased vascular permeability and smooth muscle spasm.
Anaphylactic shock develops in response to repeated administration of an allergen, regardless of the route of entry and the dose of the allergen (it may be minimal). For example, there is a known case of anaphylactic shock as a reaction to traces of penicillin in a syringe that remained in it after it had been processed, washed and boiled.
An immediate allergic reaction is characterized by rapid development, violent manifestations, extreme severity of the course and consequences.
The type of allergen does not affect the severity of anaphylactic shock. His clinical picture diverse. The less time has passed since the allergen entered the body, the more severe the clinical picture. Highest percentage deaths Anaphylactic shock occurs when it develops 3–10 minutes after the allergen enters the body.
Not determined during examination arterial pressure, or it is very low, the pulse is frequent, thread-like; heart sounds are quiet, in some cases they are almost not audible, an accent of the second tone may appear above pulmonary artery. In the lungs, upon auscultation, hard breathing and dry scattered wheezing are heard. Due to ischemia of the central nervous system and swelling of the serous membranes of the brain, tonic and clonic convulsions, paresis, and paralysis can be observed.
Bronchial asthma
(PBA) is one of the most common allergic diseases of medical workers and occupies a leading place in the prevention of occupational diseases. PBA is defined as a disease caused by exposure to allergens on the respiratory tract in the workplace of a medical worker or pharmacist.
Some epidemiological studies have shown that up to 14% of all asthma patients suffer from PBA.
Thus, among medical workers examined at the Samara Regional Center for Occupational Pathology, PBA accounted for 62.2% of all identified allergic diseases (for comparison: allergic urticaria amounted to 18.9%, allergic rhinitis - 8.9, allergic dermatitis - 10.5%). PBA is predominantly diagnosed in nurses, especially procedural nurses, which is associated with prolonged contacts of this category of medical workers with wide range substances that have an allergenic effect.
Leading etiological factors agents that cause PBA are latex, disinfectants (sulfathiazole, chloramine, formaldehyde), antibiotics, herbal medicinal raw materials, and chemical components of diagnostic kits.
One of the reliable methods for the specific diagnosis of PBA is a provocative inhalation test with minimal concentrations of aqueous solutions of allergens.
Early recognition of the disease (peak flowmetry at the workplace and at home), cessation of further contact with the allergen and timely initiation of treatment are important. To confirm professional genesis bronchial asthma it is necessary to determine the level of total IgE and allergen-specific IgE in the serum (skin testing, enzyme-linked immunosorbent assay, radioallergosorbent test) for household, pollen, fungal, and occupational allergens.
Allergic rhinitis
Prevention of occupational diseases includes early diagnosis of allergic rhinitis in order to prevent its occurrence.
Many occupational factors with which medical and pharmaceutical workers come into contact have a strong irritant effect on the nasal mucosa and lung tissue. The main symptoms of the disease are itching and irritation of the nasal cavity, sneezing and rhinorrhea, often accompanied by nasal congestion.
Occupational diseases from exposure to biological factors
Dysbacteriosis, candidomycosis of the skin and mucous membranes, visceral candidiasis develop through contact with infectious patients or infected materials, producing fungi, antibiotics (work in outpatient and inpatient medical institutions, pharmacies, bacteriological laboratories, microbiological medical industry enterprises, etc.).
When determining the degree of loss of professional ability for a medical worker in each specific case, the severity of dysfunction of the body, the degree of compensation, the patient’s ability to perform work in their main profession to varying degrees, including in ordinary or specially created conditions, as well as measures are taken into account on rehabilitation, including vocational training and retraining.
To reduce the level of occupational morbidity among medical workers, immunization and antiviral therapy are effective; doctors and paramedical workers require greater attention to their health and the use of personal protective equipment.
MAIN GROUPS OF OCCUPATIONAL DISEASES
There are 5 groups of occupational diseases of medical workers:
I. Occupational diseases from exposure to physical factors.
II. Occupational diseases from overstrain of individual organs and systems.
III. Occupational diseases from exposure to biological factors.
IV. Occupational diseases of toxic-chemical etiology.
V. Occupational allergies.
OCCUPATIONAL DISEASES FROM INFLUENCE OF PHYSICAL FACTORS
Harmful production factors of a physical nature that can cause the development of occupational diseases (OD) in medical workers include:
1. various types of ionizing and non-ionizing radiation ( x-ray radiation, laser radiation, microwave radiation, ultrasound);
2. noise;
3. vibration.
Among medical workers, the most exposed to ionizing radiation are x-ray surgical teams and specialists servicing x-ray rooms and radiology laboratories. Possible health problems: radiation sickness and malignant neoplasms.
Prevention of occupational cancer in medical workers includes primary and secondary measures. Primary prevention involves preventing the occurrence of cancer and includes hygienic regulation of carcinogens, the development and implementation of measures aimed at reducing contact with carcinogens, control of carcinogenic pollution of the working environment, prohibition of working with carcinogens for people with a hereditary predisposition to tumor diseases. Secondary prevention consists of medical examination of persons working with sources of ionizing radiation, early detection and treatment of chronic background and precancerous diseases, i.e. timely and high-quality medical examinations.
The impact of laser radiation on the body of those working with therapeutic and surgical laser installations depends both on the properties of the laser and on the specific properties of the structures on which the beam acts. Therefore, local damage to the eyes and skin most often occurs, as well as systemic effects on nervous system– vegetative-vascular dystonia, asthenic, asthenovegetative syndrome
Prevention of adverse effects of laser radiation on personnel is based on the class of lasers used. Doctors and nurses servicing diagnostic, therapeutic and surgical equipment may be exposed to the adverse effects of ultrasound in an industrial environment.
The most typical pathological effect of ultrasound is the development of peripheral autonomic-vascular disorders, sensory disorders - angiodystonic syndromes and autonomic-sensory polyneuropathy. After 3-5 years from the start of work, complaints of numbness in the fingers, paresthesia in them, and increased sensitivity of the hands to cold appear. In addition to generally accepted measures to prevent the adverse effects of ultrasound on the body of workers (preventive selection, periodic medical examinations), an important role belongs to individual protective equipment (special gloves, screens, etc.), which medical workers quite often neglect.
The adverse effects of noise lead to the development of occupational hearing loss. Noise and vibration, even at the level of maximum permissible parameters, lead to damage to the receptors in the cochlea with prolonged exposure. Among health care workers, dentists are the most susceptible to the adverse effects of noise and vibration.
Prevention of sensorineural hearing loss and its progression: reducing or eliminating the influence of industrial noise, vibration, ototoxic chemicals. Use of mass and personal protective equipment: isolation of noise sources, antiphons, earplugs.
OCCUPATIONAL DISEASES FROM OVEREXTENSION IN INDIVIDUALS
ORGANS AND SYSTEMS
The development of this category of PP leads to:
1. staying in an irrational working position (otolaryngologists, dentists);
2. staying in a forced working position (surgeons, gynecologists).
Prolonged stay in an irrational working position leads to a fairly rapid development of functional insufficiency of the musculoskeletal system, which manifests itself in fatigue and pain.
Cervicobrachial radiculopathy can develop when performing work that involves prolonged exposure to a forced working position with the torso and head tilted (dentists, otolaryngologists).
The disease is often combined with glenohumeral periarthrosis. It is formed during work related to the performance of frequently repeated movements in the shoulder joint.
Prevention of PZ of the musculoskeletal system includes: high-quality periodic medical examinations, preventive exercise therapy.
Among the professional factors influencing the development of varicose veins of the lower extremities, physical overexertion and prolonged static load in persons performing standing work, for example, surgeons, are important.
Only varicose veins of the lower extremities are recognized professionally.
Prevention of varicose veins of the lower extremities in medical workers consists of the following areas:
- exclude constitutional weakness of connective tissue, (for example, flat feet) in surgical specialists;
- diagnose the compensated stage of varicose veins, promptly employ patients without reducing their qualifications (retraining taking into account the main profession and active medical rehabilitation is possible);
- organize a work regime that, if possible, excludes long periods of standing (operating days, comfortable microclimate, rooms for physical and psychological relaxation, etc.), preventive physical therapy.
Progressive myopia develops if working conditions provide for increased visual strain when distinguishing small objects at close range. Among medical workers, quite a large group of specialists working with optical instruments (microscopes, including operating rooms) are susceptible to this. Optical devices create a high load on vision, the need to constantly focus the object and merge paired images in conditions of forced separation of accommodation and convergence. All this leads to a sharp load on the oculomotor systems of the visual organ in microsurgeons, histologists, microbiologists, laboratory assistants, etc., causing or increasing the development of myopia.
A high percentage of myopia has also been identified among dentists and otolaryngologists. Prevention includes:
- professional selection and high-quality conduct of preliminary and periodic medical examinations;
- physical exercise, gymnastics for the eyes, the use of orthoscopic glasses for precise work at close range.
OCCUPATIONAL DISEASES FROM EXPOSURE
BIOLOGICAL FACTORS
OCCUPATIONAL DISEASES OF TOXIC-CHEMICAL ETIOLOGY
Includes the following groups of diseases:
- upper respiratory tract diseases;
toxic and toxic-allergic hepatitis;
blood diseases of toxic-allergic origin;
damage to the nervous system of toxic-allergic origin.
The irritating effect manifests itself not only upon exposure to the respiratory system, but also upon contact with the skin and mucous membrane of the eyes. In medicine, among irritating substances, compounds of chlorine (bleach, hydrochloric acid) and sulfur (hydrogen sulfide, sulfuric acid), nitric, acetic acids, formaldehyde and others are quite widely and constantly used. The duration of work also affects the prevalence of the lesion - first chronic rhinitis develops, then chronic pharyngitis and laryngitis.
Toxic and toxic-allergic hepatitis can develop in medical workers from exposure to anesthesia and antibacterial drugs, so they can occur in surgeons, anesthesiologists, and operating room nurses.
Toxic lesions arise from the effects of antibacterial agents (penicillins, cephalosporins, aminoglycosides) and chemotherapeutic agents used in oncology (brulomycin, rubomycin, leukeran, 6-mercaptopurine), local anesthetics. The risk group includes personnel working with these drugs and pharmacy employees. Routes of entry: inhalation and transcutaneous.
Preventive measures for medical workers who have constant contact with antibiotics include means of collective (ventilation) and individual protection (overalls, masks, etc.).
PROFESSIONAL ALLERGOSES
In addition to drugs that are full-fledged allergens and haptens, immunopathological processes can be caused by chemical reagents used in laboratory practice; substances for anesthesia, disinfection, detergents used in medical institutions, biological preparations (vaccines, serums), latex gloves (the most common cause of sensitization), medicinal plant materials in pharmaceutical factories and pharmacies.
Allergic dermatitis, allergic rhinitis, urticaria, and bronchial asthma are more common.
Prevention is as follows:
Persons having allergic diseases skin, upper and lower respiratory tract, work in contact with allergens and chemicals is contraindicated.
- early detection of allergy pathology and rational employment without contact with allergens.
Human labor activity is associated with risks of developing specific pathologies inherent in a particular profession. Prevention of such diseases is among the priorities of the state.
People's professional activities, to one degree or another, have a negative impact on their health. There are a number of measures designed to minimize such impacts as much as possible. Prevention of occupational diseases includes medical, physical and social measures.
Occupational diseases are considered to be those whose occurrence is caused by working conditions. Particular attention is paid to the prevention and protection of workers in hazardous industries and personnel of medical institutions from specific pathologies.
Each profession has its own risk factors. They may be as follows:
- chemical;
- dusty;
- physical;
- psychological;
- biological.
Chemical factors cause acute and chronic poisoning, dermatitis, onychia, folliculitis, melasma. Dusty production causes diseases respiratory system and damage to the mucous membranes.
Physical factors can be divided into 2 groups. The first includes vibration, ultrasonic, electromagnetic, radiation, and temperature effects. They cause the development of such occupational diseases as electroophthalmia, radiation, decompression or vibration sickness, and vegetative polyneuritis.
The second group of occupational diseases is caused by physical fatigue and overexertion. These include pathologies of the musculoskeletal system, neuroses, arthrosis, and neuralgia. Eyes can suffer from overwork vocal cords, spasms occur.
The prevention of blood-borne infections (HIV, syphilis, viral hepatitis, malaria) requires special attention. The risk of contracting such diseases exists among health care workers who come into contact with the blood of patients (surgeons, nurses, laboratory assistants, traumatologists).
Representatives of any profession can be exposed to psychological factors to varying degrees. However, they most affect teachers, police officers, and health and social service workers.
Working with people requires constant control of your emotions. As a result of constant mental stress, depression and nervous breakdowns are possible.
Prevention of occupational diseases primarily consists of monitoring safety precautions, familiarization with which is mandatory for all workers in any field of activity.
The healthcare system contributes to the prevention of occupational diseases through regular medical examinations, development and implementation of hygiene standards.
Clinical examination of the working population is aimed at early detection and timely treatment of various pathologies that are formed under the influence of the conditions in which work activity is carried out.
Enterprise workers are taught how to properly use personal protective equipment during technological process and carrying out their professional duties, and also develop their skills in providing assistance in case of work-related injuries.
In the prevention of occupational diseases there is no last role physical education and sports play a role. They contribute to the overall strengthening and healing of the body.
Prevention of diseases among medical staff
The risk of developing occupational diseases among workers in medical institutions is quite high. Infections are the most frequently reported infections among doctors and other hospital staff. This is due to regular contact with sick people.
Bloodborne infections are especially dangerous, each of which poses a serious threat to human health and life. HIV enters the body through the blood, effective medicine from which it does not exist.
This virus is very insidious. HIV deprives the human body of the ability to defend itself against infections by destroying cells of the immune system. Most HIV infections among medical staff occur through blood when the skin is accidentally damaged by sharp instruments (scalpel, needle).
To prevent HIV infection, it is necessary to follow safety rules when working with carriers of blood-borne diseases. Examination and collection of biological material from patients must be carried out wearing masks and medical gloves, which must be disposed of upon completion of the manipulations.
If there is a danger of contracting HIV (contact with the biomaterial of a potential carrier of infection), you should start preventing the disease with antiretroviral drugs as soon as possible.
The list of blood-contact infections includes viral hepatitis (B, C), which affects the liver and rarely gives hope for cure. Among medical workers who come into contact with the blood of patients, a high percentage of syphilis infections is recorded.
When performing medical procedures on patients who are carriers of bloodborne infections, it is necessary to use personal protective equipment and disposable instruments. Premises where potentially infected material is handled must be thoroughly disinfected.
The work of medical personnel involves not only the risks of contracting infections. The air in work areas is saturated with medicinal, disinfectant, drugs, chemical reagents, which increases the risk of developing allergies.
Most medical and diagnostic equipment is a source of ionizing rays. Regular presence in their zone causes leukemia, neoplasms, and radiation sickness.
Many health workers have musculoskeletal diseases. The presence of such pathologies is due to the specifics of medical work. Healthcare workers spend a significant portion of their time on their feet, in an awkward position, bending over the patient.
To a large extent, medical staff are influenced by psychological factors. A source of stress is working with seriously ill, mentally unstable and dying people. Night shifts have a negative impact on the health of medical workers.
Increased physical and psychological stress leads to professional burnout, which is characterized by chronic fatigue, emotional and mental exhaustion. Surgeons, traumatologists, and hospice workers are more susceptible to this syndrome.
Prevention of professional burnout includes conversations with a psychologist, playing sports, rational distribution of workload and responsibility between members of the work team. It is necessary to follow a work and rest schedule (go on vacation in a timely manner and avoid working seven days a week).
The doctor’s well-being largely determines the quality of the treatment he provides. Physical education and sports are of great importance in promoting health, and, therefore, in preventing professional burnout.
Physical culture in the prevention of occupational diseases
The role of physical culture in the prevention of occupational diseases primarily comes down to general strengthening and increasing the body’s resistance to various infections.
Sports activities are extremely necessary for people whose professional activities require a long period of inactivity. Certain means of physical education are selected taking into account the body’s preparedness and possible contraindications to them.
The working day of office staff should include periodic industrial gymnastics classes.
Their effect on the body is to relieve muscle tension, increase working capacity and prevent pathological changes in posture. Prevention using physical education methods reduces the overall morbidity of employees and significantly reduces occupational injuries.
The forms of physical culture involved in the prevention of occupational diseases are as follows:
- breathing exercises;
- relaxation;
- morning work-out;
- exercises that strengthen the muscle corset;
- outdoor games.
For employees who have health problems that can be corrected using physical education methods, group therapeutic and recreational classes are conducted in the fresh air or in specially designed rooms.
A set of preventive measures is aimed at strengthening the general health of the working population, ensuring safe working conditions and preventing occupational diseases. Do not neglect various types of physical education. Sport is the best assistant in improving health.
M.A. Sheveleva
OCCUPATIONAL DISEASES OF MEDICAL
WORKERS
St. Petersburg State University
The risk of developing occupational diseases in some areas of health care can be compared with leading industries. Medical workers may be exposed to various unfavorable factors in the working environment and work process, which include: chemical substances and biological agents, high intellectual and neuro-emotional stress, ionizing and non-ionizing radiation, forced working posture, overvoltage of analyzer systems, noise, vibration, carcinogens and other factors.
Progress in medicine, on the one hand, improves the quality and efficiency of diagnostic and treatment care, and on the other hand, creates new working conditions with little-studied nature of the effect on the body of personnel.
According to the results of studies carried out for last years The highest level of occupational diseases is observed among nurses, and among doctors - among pathologists, infectious disease specialists and dentists.
In terms of the severity of adverse factors among medical workers, toxic-chemical factors occupy a special place. Contamination of the working premises of medical institutions with medicinal substances, especially antibacterial ones, can cause the development of occupational diseases in health workers (allergosis, toxic lesions accompanied by dysbacteriosis).
The effect of the biological factor on medical workers is manifested in the constant contact of personnel with infected patients, which not only increases the likelihood of occupational infection, but also causes changes in the immunological status and reactivity of the worker’s body. Viral hepatitis, tuberculosis and HIV infection are more often reported among health workers than other infections.
Of the physical factors, along with the impact of ionizing radiation, which causes the development of radiation sickness, increasing attention is paid to the effect of non-ionizing radiation, in particular, ultrahigh frequencies (microwave), electromagnetic waves, which have found wide application in medicine. Decimeter microwave waves have an effect on the central and peripheral nervous system, the influence of the millimeter wave range affects the cardiovascular system to a greater extent, the centimeter and millimeter ranges have a negative effect on the blood.
The factor of overstrain of individual organs and systems primarily manifests itself among microsurgeons. The structure of diseases of microsurgeons is dominated by diseases of the cervicothoracic and lumbosacral spine, which arise even with short work experience.
A feature of the work of many categories of health workers is the combined impact of various factors in the working environment. Thus, sensorineural hearing loss caused by exposure to acoustic noise develops 3 to 5 times more often if it is combined with the use of antibiotics that have an ototoxic effect.
The high level of morbidity among physicians dictates the need to develop a unified organizational system of professional safety.
Shlomin V.V., Gusinsky A.V., Vazhenin S.O., Sedov V.M., Lebedev L.V.,
Nikolaev D.N., Ivanov A.S., Yurtaev E.A., Kasyanov I.V., Didenko
Yu.P., Sharipov E.M., Mikhailov I.V.
TREATMENT OF ABDOMINAL AORTIC ANEURYSMS IN PATIENTS OVER 70 YEARS OLD
St. Petersburg, St. Petersburg State Medical University named after acad. I. P. Pavlova; GMPB No. 2; State Research Institute of Cardiology named after Acad. A.V. Almazova
Abdominal aortic aneurysms are one of the most dangerous vascular diseases. From 1998 to 2004, we observed 98 patients aged 71-91 years (average 77.1 ± 0.22 years) suffering from infra- or juxtarenal aneurysms of the abdominal aorta. 60 patients underwent surgery, 38 refused surgery. The control group consisted of 122 patients with a similar disease (80 operated and 42 not operated), but younger than 70 years (average age 64.1 ± 0.23 years).
When performing the intervention, we were guided by a certain algorithm. Given the large number of concomitant diseases, patients were prepared for surgery with the involvement of various specialists: cardiologists, pulmonologists, gastroenterologists, endocrinologists, etc. The complex of pain-relieving measures included epidural anesthesia, which was also used in the postoperative period for analgesia and combating intestinal paresis . As operational access preference was given to the modified Robe approach or thoracophrenolumbotomy, which did not require contact with abdominal cavity and provide sufficient visibility. For juxtarenal aneurysms, thoracophrenolumbotomy was used. For small and medium-sized aortic dilatations, to reduce intraoperative blood loss, the lumbar arteries were ligated until the aneurysmal sac was opened. For the same purpose, preference was given