Introduction. One of the most important directions in the development of health care in the Russian Federation is the improvement of approaches to maintaining the health of workers. In order to achieve this aim measures are being taken to prevent the development of occupational diseases, ensure the proper quality and availability of medical care in the occupational medicine and the staffing of medical organizations. Particular attention is paid to preventive measures, a healthy lifestyle and its promotion, and the identification of early signs of occupational diseases.

The aim of the article is to determine perspective directions for the development of the health care system for workers with harmful (or) hazardous factors and working conditions, including an analysis of volumetric and structural indicators of medical activity as well as existing and developing legal acts regulating medical care for occupational medicine.

Materials and methods. The legal acts regulating the health care of the workers, data from scientific research and scientific publications, statistical reports (form No. 30 "Information about the medical organization"; reporting materials of occupational medicine centers of the Russia's federal constituent entities) for the period 2016-2020 were studied and analyzed.

Results. Today measures to improve the legal regulation of the health care of workers are one of the priority tasks of the state. Medical activity in the health of workers consists in carrying out preventive measures (determining a list of harmful and(or) dangerous production factors and work during the performance of which mandatory preliminary medical examinations are carried out upon admission to work and periodic medical examinations; a special assessment of working conditions; mandatory preliminary and periodic medical examinations), examinations of professional suitability, examinations of the connection between the disease and the occupation; medical care in occupational medicine; medical rehabilitation for medical reasons, medical and social expertise, social rehabilitation, spa and sanatorium treatment. In accordance with statistical data 654 occupational pathologists worked in the Russian Federation in 2020. In medical organizations 1961 full-time positions of occupational pathologists were organized, while the number of occupied positions was 1311, i. e. the staffing of occupational pathologists was 66.8%. A downward trend in the staffing of medical organizations with occupational pathologists has been noted over the past few years. Only 18.2% of all occupational pathologists had the highest category; 74% of occupational pathologists do not have a qualification category. The insufficient level of staffing and qualification of occupational pathologists has led to an increase in the burden on doctors and a decrease in the quality of preventive, therapeutic and diagnostic measures. The number of persons subjected to mandatory preliminary and periodic medical examinations amounted to 8.9 and 9.5 million people in 2018 and 2019 respectively. 7.43 million people were subject to inspections in 2020. The proportion of those examined within 3 years (from 2018 to 2020) remains at the same level and ranges from 98.2 to 98.6%. The share of examined persons with temporary/permanent medical contraindications to work in 2019 and 2020 did not change and amounted to 1.4%. In 2018 this index was 1.8%. At the same time the volumetric and structural indicators of medical activity in occupational medicine are poorly understood because occupational diseases are not socially significant and they are not recorded in the Unified State Health Information System. In this regard it is advisable to optimize approaches to statistical analysis: take into account the volumetric and structural indicators of medical activity in the system of protecting the health of workers including examinations of professional suitability and examinations of the connection between the disease and the occupation, mandatory preliminary and periodic medical examinations.

Limitations. The study examined the results of a limited number of statistical forms.

Conclusion. The regulatory legal acts in the Russian Federation makes it possible to provide workers with high-quality and affordable medical care. Currently, serious work is underway to modernize the legal acts regulating the protection of the health of workers in order to save the health of workers and their efficiency by obtaining and analyzing objective information sufficient to develop evidence-based tactical and strategic management decisions for the prevention of professional, professionally conditioned and general morbidity, reducing disability due to occupational diseases, reducing labor losses due to illness, maintaining working longevity. Volumetric and structural indicators of medical activity in occupational medicine are currently little studied, in this regard it is advisable to optimize approaches to statistical analysis. Special attention should be paid to the quality of staffing of medical organizations: the quality of continuous professional education of occupational pathologists. It is advisable to continue work to increase the availability of medical care in occupational medicine and the effectiveness of organizing mandatory medical examinations including telemedicine technologies and mobile medical teams. Mandatory medical examinations of workers must be carried out including using technical means and medical devices that provide automated remote transmission of information about the health status of workers and remote monitoring of their health status.

Ethics. The authors were guided by the ethical principles of medical research as outlined in the latest revision of the Declaration of Helsinki by the World Medical Association.

Contribution:
Bukhtiarov I.V. — editing, making fundamental changes, approving the final version of the article;
Zemlyakova S.S. — data capture, analysis and interpretation of data, writing the text;
All authors — the concept and design of the study.

Funding. The study had no funding.

Conflict of interests. The authors declare no conflict of interests.

Received: 29.06.2022 / Accepted: 07.07.2022 / Published: 15.07.2022

The main direction of the state social policy is to ensure the priority of preserving and improving the health of the working population as the most important productive force of society, determining the national security of the country and its economic development. On the background of the projected decline in the ratio of the population of working age and older than able-bodied, an important task is to prevent the development of occupational and other diseases, to reduce cases of early loss of ability to work.

One of the indicators of the deterioration of the workers health is a significant weighting of the primary pathology detected, the predominance of chronic diseases leading to loss of working capacity. For a number of reasons, occupational diseases are more often detected in the late stages of development, when irreversible changes in the body already occur. Assessing the harmful effects of working conditions and reducing it to the level of acceptable risks allows you to preserve the professional health of employees, prevent the development of professional and production-related pathology. Especially important in this case is the examination of trained workers in order to identify early signs of exposure to harmful production factors, including preventing the development of their pronounced forms, conducting an examination of professional suitability and examination of the connection of the disease with the profession, early diagnosis of general somatic diseases as a predisposing and aggravating factor in the formation of occupational diseases.

In workers who have been in contact with a harmful and(or) dangerous production factor for a long time, individual pathognomonic disorders are observed in the early stages, without the formation of a clearly defined clinical syndrome, which is not enough to establish a clinical diagnosis of the disease but suggests the development of early signs of a specific effect of the factor. Early detection of signs of occupational diseases is most effective and feasible in the process of periodic medical examinations of employees, including in occupational pathology centers, and should serve as a basis for subsequent therapeutic and preventive measures to reduce the risks of developing occupational pathology.

Based on the results of the literature analysis, it should be concluded that there is a need for modernization and modification of preventive measures, which are the basis for creating conditions for preserving the health and longevity of the working population of the country.

Ethics. The study was carried out in compliance with ethical standards.

Contribution:
Bukhtiyarov I.V. — research concept and design, writing the text;
Kuzmina L.P. — research concept and design, data collection and processing, writing the text, editing;
Izmerova N.I. — data collection and processing, writing the text, editing;
Golovkova N.P. — research concept and design, data collection and processing, writing the text;
Nepershina O.P. — data collection and processing, writing the text, editing.

Funding. The study had no funding.

Conflict of interests. The authors declare no conflict of interests.

Received: 11.07.2022 / Accepted: 13.07.2022 / Published: 15.07.2022

5G mobile communication system networks improvement leads to scenarios for the use of electromagnetic energy in various sectors of the economy variety increase and radiofrequency electromagnetic fields (EMF) person’ exposure with expansion of the exposed by occupational and non-occupational exposure contingent including. Base station EMF distinctive feature is its complex frequency-time and spatial dynamics with constant control signals that should be taken into account in modern EMF control methods.

International practice in case of cellular base stations EMF assessment uses maximal values determination: theoretical and actual levels. EMF theoretical maximal values characterize base station operation mode under highest network load, highest data traffic and time-frequency radio channel resource full usage at the maximum permitted transmission power. Actual maximum EMF levels determination approach is base stations EMF evaluation alternative principle and is based on practically achievable maximum EMF emission, stochastic nature of base station signals with taking into account.

The approaches to statistical assessment of actual maximum exposure levels are becoming a priority for international practice of base station EMF assessment and control due to adaptive antenna technologies in 5G cellular networks development.

This approach to realistic EMF exposure assessment is fundamentally new for Russian practice and will require methodological updating of regulatory framework as well as comprehensive researches with network operators, including approaches to selective measurement results extrapolation for implementation.

Ethics. The study did not require the ethics committee conclusion.

Contribution:
Perov S.Yu. — research concept and design, editing;
Belaya O.V. — research concept and design, data collection and analysis, text writing;
Rubtsova N.B. — research concept and design, editing.

Funding. The study had no funding.

Conflict of interests. The author declares no conflict of interests.

Received: 25.04.2022 / Accepted: 21.06.2022 / Published: 15.07.2022

Introduction. The safety of exposure to the population of a growing number of sources of electromagnetic fields everywhere, both in work and at home, has become a public health problem. This article presents the results of research on the study of the potentially adverse effects of electromagnetic fields of industrial frequency on the reproductive system of personnel of energy supply institutions.

The aim of the study is to explore the possible adverse effects of electromagnetic fields of industrial frequency on the male reproductive system.

Materials and methods. The object of the study was 144 employees engaged in the repair and operation of power grid facilities and 40 employees who are not exposed to electromagnetic fields of industrial frequency. To assess laboratory parameters, blood samples were taken, followed by determination of the levels of total testosterone, free testosterone and globulin binding sex hormones.

Results. The subjects of the main group revealed a high incidence of prostatic hyperplasia and chronic prostatitis. The employees of the main group had lower concentrations of sex hormones (p<0.05) in relation to similar indicators of the control group. A negative correlation was revealed between the levels of total, free testosterone and sex hormone binding globulin with experience (r=–0.36 p=0.009; r=–0.264 p=0.06; r=–0.349 p=0.01, respectively).

Limitations of the study. The study is limited by the number of highly trained workers exposed to electromagnetic fields of industrial frequency.

Conclusions. The results of the study indicate the negative impact of electromagnetic fields of industrial frequency on the reproductive system of employees engaged in the repair and operation of power grid facilities. With an increase in the length of service of employees, a decrease in the concentration of globulin binding sex hormones, total and free testosterone was found. Among workers exposed to electromagnetic fields of industrial frequency, a high prevalence of prostate pathologies was revealed.

Contribution:
Kuzmina L.P. — concept and design of the study, editing;
Kislyakova A.A. — research concept and design, data collection and processing, text writing;
Bezrukavnikova L.M. — concept and design of research, editing;
Khotuleva A.G. — writing text, editing;
Varakuta A.L. — writing text, editing.

Financing. The study had no funding.

Conflict of interest. The authors declare that there is no conflict of interest

Received: 16.06.2022 / Accepted: 24.06.2022 / Published: 15.07.2022

Introduction. Recent studies have shown that working conditions at mining enterprises remain harmful and dangerous. We characterize the working conditions by a set of factors of the production environment that affect the functional state of the body of workers and their working capacity. It depends on the equipment used, technologies, objects, products of labor. They are specific to each enterprise. In these conditions, the definition of occupational risks of violation of the health of miners becomes particularly relevant.

The study aims to assess the current working conditions, the state of professional performance, to determine the risks of health disorders of the drivers of mining machines at ore quarries.

Materials and methods. The researchers have conducted hygienic studies to assess production factors at ore quarries. We have presented an analysis of materials for a special assessment of working conditions at workplaces for ore quarries belonging to the Mining and Metallurgical Trade Union of Russia. Experts have summarized materials on occupational morbidity of employees over the past five years. The researchers have performed a cross-sectional epidemiological study to assess the risk of developing chronic general somatic diseases in mining machine drivers. 

Results. The article provides a hygienic assessment of working conditions in modern quarries, shows the complex impact on workers of the dust and gas factor, noise and vibration, microclimate. The authors present classes of working conditions for employees of the main professions, the results of a special assessment of working conditions. We have given an analysis of occupational morbidity in the quarries included in the GMPR and GOK "Lebedinsky" over the past five years.

Researchers have found that diseases of the musculoskeletal system and connective tissue, as well as diseases of the circulatory system are production-related in workers engaged in open-pit mining.

Conclusion. In the conditions of using high-performance mining equipment for open-pit mining of ores, a complex of production factors affects workers of leading professions.

The authors give a general assessment of the working conditions at the workplaces of these professions: this is a harmful third class with varying degrees of harmfulness.

The current set of production factors determines the level of occupational morbidity, which has been trending downward in recent years. The leading place belongs to vibration sickness, it is closely related to the increased values of the maximum permissible levels and the equivalent adjusted level of vibration velocity at the workplaces of drilling rig drivers, excavators and drivers of heavy-duty dump trucks. The high prevalence and risk of developing chronic diseases of the musculoskeletal system and connective tissue and diseases of the circulatory system, as well as a significant increase in indicators with an increase in work experience in harmful working conditions, allow us to speak about the production conditionality of these diseases in workers engaged in open-pit mining.

Ethics. This study did not require the conclusion of the Ethics committee.

Contribution:
Prokopenko L.V. — concept and design of the study, editing;
Chebotarev A.G. — material collection and processing, statistical data processing, text writing;
Golovkova N.P. — research design; material processing, editing;
Leskina L.M. — material collection and processing, statistical data processing, text writing;
Nikolaev S.P. — collection and processing of material, statistical processing of data.

Funding. The study had no funding.

Conflict of interests. The authors declare no conflict of interests.

Received: 20.06.2022 /Accepted: 10.07.2022 / Published: 15.07.2022

Introduction. Due to difficult working conditions, coal industry workers may develop negative emotional states that can increase the risk of developing cardiovascular diseases. The relationship of negative emotions with the frequency of risk factors in coal industry workers has not been studied enough, while its early determination will allow the elaboration of preventive and psycho-corrective measures.

The aim was to study the relationship of negative emotional states with the frequency of risk factors for the development of cardiovascular diseases in coal industry workers with occupational pathology.

Materials and methods. Using the DS14 (negative affectivity, social suppression) and Spielberger-Khanin (personal anxiety, situational anxiety) questionnaires we examined 196 miners with occupational diseases (dust lung pathology, diseases of the musculoskeletal system, vibration disease).

Results. We identified a high frequency of negative affectivity (44.7% of the subjects), social suppression (69%), personal anxiety (35%), and situational anxiety (20%); the relationship between negative emotional states and risk factors for the development of cardiovascular diseases was determined. We revealed the relationship between negative emotional states and risk factors for the development of cardiovascular diseases, such as smoking, arterial hypertension, low physical activity, the presence of prolonged stress and severe perception of stress. A high level of personal anxiety is most closely related to the frequency of such risk factors as severe perception of stress, the presence of prolonged stress, arterial hypertension, and low physical activity.

Limitations. The study is limited to a sample of 196 miners with occupational diseases, surveyed using the DS14 and Spielberger-Khanin questionnaires.

Conclusions. A high level of negative emotional states, including personal anxiety, was revealed among coal industry workers with occupational diseases, which to the greatest extent determines the frequency of risk factors for the development of cardiovascular pathology. An early determination of the relationship between negative emotional states and the frequency of risk factors for the development of cardiovascular diseases in this group of workers will make it possible to create a program of preventive and psycho-corrective measures.

Ethics. The study was conducted in compliance with the ethical principles of medical researches involving humans in accordance with the Declaration of Helsinki of the World Medical Association of the latest revision.

Contribution:
Danilov I.P. — the concept and design of the study, data collection and processing, writing the text;
Vlakh N.I. — the concept and design of the study, writing the text;
Pestereva D.V. — data collection and processing;
Paneva N.Ya. — data collection and processing;
Logunova T.D. — editing.

Funding. The study had no funding.

Conflict of interests. The authors declare no conflict of interests.

Received: 27.04.2022 / Accepted: 06.06.2022 / Published: 15.07.2022

Introduction. It is known that workers employed in harmful and dangerous working conditions initially have better health characteristics compared to the population as a result of medical and professional selection. Harmful production factors cause significant damage to health and can lead to the formation of occupational diseases. Preventive medical and rehabilitation care for patients with occupational pathology, combined with social and economic support measures, contributes to maintaining health and increasing life expectancy. It is important to understand how medical and social assistance to patients compensates for the damage caused to the health of workers by harmful working conditions.

The study aims to compare the life expectancy of coal miners with an established diagnosis of occupational disease (OD) and the male population of the same region.

Materials and methods. The researchers formed a cohort of coal miners in the Rostov region based on the materials of the database of the State Medical Institution of the Rostov region "Medical and Rehabilitation Center No. 2". All surveyed coal miners have established occupational diseases in different years. The observation period was 26 years from 01.01.1990 to 31.12.2015. Of the total cohort at the end of the observation period, 1,898 people were alive, 8082 people died. The experts examined the working conditions of miners, the average age of registration of the OD, depending on the nosological form. The researchers have conducted a comparative assessment of their life expectancy and the life expectancy of the male population of the same region, calculated from mortality tables.

Results. The calculation of the average life expectancy of miners showed that its value in subgroups with different forms of OD differed significantly depending on the diagnosis: from 58.7 to 68.2 years. A comparative analysis of the life expectancy of coal miners with an established diagnosis of OD and in population control revealed a lower life expectancy of miners. The smallest differences in life expectancy we have noted in those miners who have a diagnosis of pneumoconiosis. Their life compared to the men of the Rostov region was shorter by less than a year. At the same time, miners with a diagnosis of occupational bronchitis lived 5.3 years less and with a diagnosis of vibration disease — 4.8 years compared to the population control.

Conclusion. The study showed that coal miners diagnosed with occupational diseases have a lower average life expectancy than in the population, despite the "healthy worker effect", which we have as a result of medical selection and self-selection of persons to work in contact with harmful production factors. The lower life expectancy of workers with a diagnosis of occupational diseases we trace both in total for all diseases, and for individual forms of OD.

Ethics. The authors have conducted the study in compliance with Ethical standards.

Contribution:
Tikhonova G.I. — research concept and design, text writing, editing;
Piktushanskaya T.E. — concept and design of the study;
Gorchakova T.Yu. — statistical data processing, text writing;
Serebryakov P.V. — writing text, editing.

Funding. The study had no funding.

Conflict of interests. The authors declare no conflict of interests.

Received: 26.04.2022 / Accepted: 07.07.2022 / Published: 15.07.2022