Introduction. Firefighters’ labor activity characterized by extreme working conditions and the complex impact of harmful and dangerous factors of the working environment, including physical, chemical, biological, and psychophysiological factors, as well as hazardous fire factors and their associated manifestations. The chemical factor is one of the leading hazard factors and poses a significant danger to the life and health of firefighters. Currently, plenty of synthetic polymeric materials are used in construction. During their combustion and thermal decomposition into the air, a wide range of chemicals are released, including superecotoxicants dioxins, which have a cumulative effect.

The aim of the study is to provide a hygienic assessment of air pollution with the main harmful substances in the fire zone, to determine dioxins in the air and in the blood of firefighters with different work experience.

Materials and methods. Study of the working area air for the content of 7 pollutants carried out by classical and express methods at different stages of eliminating 56 fires of various localization. There were 350 people with various experience of professional activity, directly involved in fire extinguishing and conducting inspections (as part of an investigation at the fire sites). They were examined to assess the influence of harmful chemical factors on the firefighters’ body. As a control group, 82 rescuers examined.

Results. A day after extinguishing a fire, the concentrations of most toxic combustion products decreased to levels close to MPC. The exception was dioxins, which high concentrations in the surface air at the fire site persisted for more than two weeks. High concentrations of dioxins in blood plasma found both in the group of firefighters directly involved in firefighting and the group conducting inspections at the fire site. Analysis of the data showed a significant increase in the concentration of dioxins in the blood with an increase in the length of work experience.

Conclusions. Although the main path of entry of dioxins into the human body considered to be alimentary, for firefighters who perform work at their high concentrations in the air, the respiratory route of intake becomes significant.

Introduction. Preserving the health of the working population is a priority of state policy. The welding process, which is used in many areas of industry, refers to technological processes with harmful working conditions. Monitoring of the production environment, which determines the extent to which the worker is exposed to harmful factors and helps to establish the connection of a particular disease with production activities, is particularly relevant.

The aim of the study is to carry out a hygienic assessment of the air in the working area through the conducted studies, to identify risk factors for the health of welders, considering the peculiarities of forming air environment in various types of welding and the technological process organization.

Materials and methods. Hygienic studies were carried out on the basis of two large enterprises of mechanical engineering and shipbuilding in Saint Petersburg and on more than 30 separate welding sites of enterprises in the North-West region in 2010-2018.

Results. It is established that working conditions during traditional types of welding are determined by the organization of the welder’s workplace and the type of welding. The most unfavorable conditions for the formation of the air environment are characterized by welding of large-sized metal structures, welding in isolated spaces and metal cutting, where existing technical solutions for the installation of localized exhaust ventilation systems are not effective enough. Concentrations of manganese reach 1.6-2.9 mg / m³, carbon monoxide-32-61 mg/m³, nitrogen dioxide-0.8-1.6 mg/m³. An underestimated factor in the welder’s work is the stripping operation that accompanies most welding processes. The dust content reaches 15 mg/m³. The occupational health risk of employees was assessed based on the indicators of morbidity with temporary disability, depending on their age and work experience.

Conclusions. The implementation of advanced ventilation technologies, improvement of welding equipment, welding methods and materials, expansion of the use of laser welding, and introduction of effective personal protective equipment will help to minimize the risk factors for the health of welders while ensuring the safety of the air environment.

Introduction. Issues of protecting and strengthening the health of the working population are among the most important problems of modern occupational medicine and healthcare as a whole.

The aim of the study was to establish the causes for the development, structure and prevalence of occupational pathology in the Arctic enterprise workers with varying lengths of employment.

Materials and methods. We studied data on 8609 newly diagnosed occupational diseases registered in 6833 employees of enterprises in the Arctic zone of Russia in 2007-2018.

Results. It has been established that occupational health disorders that develop in the first 10 years and in later periods of work have significant differences. Earlier forms of occupational pathology are relatively more often formed in women (25.0%), younger people (46.5 ± 0.6 years), health care workers (7.1%), and under acceptable working conditions (9.0%).A specific feature of their development is the more frequent exposure to chemical (25.0%) and biological factors (6.1%) due to imperfection of sanitary installations (7.1%), occupational contact with an infectious agent (3.8%), and inappropriate use of personal protective equipment (3.3%). Intoxications, especially their acute forms, are of greater importance (9.9%) in the structure of occupational pathology of these workers. Chemical and biological factors have been shown to play greater role in the development of health disorders in workers with an experience of up to 10 years, while vibration (hand-arm and whole-body) and aerosols of mainly fibrogenic effect were more important as causative factors in workers with an experience of 11-30 years, and noise - in workers with an experience of more than 30 years. With an experience of less than 10 years, 57.1% of health problems were established as a result of independent requests for medical assistance by workers, while with an experience of more than 10 years 53.0% -60.5% of diseases were diagnosed for the first time as a result of periodic medical examinations.

Conclusions. It is necessary to improve the prevention of occupational pathology in the early years of experience, especially among the workers exposed to chemical and biological harmful production factors.

Introduction. 15-20% of the working population is engaged in various degrees of night work, which is a risk factor for many chronic diseases. The most significant causes are the duration, frequency, and degree of disruption of the daily rhythm — the length of shift work, the frequency of night shifts, the possibility of short sleep (napping) in the night shift. The age, gender, and chronotype of the employee are most often considered as indicators of vulnerability to night work (VNW), but the effectiveness of using these individual characteristics in predictive models of disease risk during shift work remains unclear.

The aim of the study is to use the proposed indicator of VNW to investigate its dependence on age, length of shift work, gender, chronic fatigue, health status, labor intensity and working environment conditions.

Material and methods. Two indicators were used: usual fatigue of the employee more when working in the night shift than when working in the day shift (VNW. 1); great fatigue from evening and night work (VNW. 2). The following groups were Studied: 1 group GR1-688 employees of continuous production enterprises and health organizations that use working modes with night shifts; GR2-298 employees of an oil refinery; GR3-679 employees of education and health care; GR4-630 University teachers. Employees were asked about their health status, symptoms of chronic fatigue and its professional and non-professional factors and working conditions. The level of labor intensity of GR1 and GR2 employees was assessed. Was used the annual increase in risk indicator (AIR) to study the age’s and experience’s dynamics of health status (AIR_ag and AIR_ex). Was used data on diseases detected during the medical examination of employees of GR1 and GR4.

Results. In the first year of shift experience, 50-55% of employees in groups GR1 and GR2 are tired during the night shift, more than during the day. With 2 years of experience, such workers become about 2 times less, then within 10 years the risk of VNW. 1 gradually increases to a level close to the value in the first year of service. Employees of GR1 and GR2 were not found to have any dependence of VNW. 1 from the age range of 25-64 years. In GR4, the V-inverse relationship of VNW. 2 is established from the age. With the same professions at oil refinery VNW. 1 is more often observed in women ((RR=1.17;0.49-2.8). For different health indicators the ratio of AIR_ex/AIR_ag amounted from 2.4 to 5.0. In GR1 at VNW. 1 an increased risk of chronic infectious diseases has been identified (RR=13.6; 1.67-111.0) and onychomycosis (women — RR=2.45 (2.023.00); men RR=1.49 (0.96-2.30). The V-shaped dependence of the risk of VNW. 1 is established. 1 on the intensity of labor.

Conclusions. When working with night shifts, 30-50% of employees are more tired when performing the same work at day shift. These workers do not adapt to night shifts. When working with night shifts, the risk of various chronic health disorders is 2.4-5 times greater than their age trend. Long-term VNW. 1 is one of the signs of the development of chronic fatigue and deterioration of the overall health of the employee. The employee's risk of VNW increases when exposed to a variety of professional and non-professional chronic stressors.

Introduction. A significant number of registered occupational diseases are accompanied by social and economic losses. The structure and levels of occupational and work-related diseases are cause-and-effect dependent on the quality of working conditions and the intensity of exposure to harmful factors of the production environment and the labor process.

The aim of the study is to determine the safe length of work experience under the influence of a combination of adverse factors of the working environment based on the application of the methodology for assessing the health risk of workers (for example, drivers of locomotive crews of railway transport).

Materials and methods. Hygienic assessment of working conditions of drivers based on the current regulatory documentation (R 2.2.2006-05 Occupational health. Guidelines for the hygienic assessment of working environment and labor process factors. Criteria and classification of working conditions; Appendix No. 1 to the order of the Ministry of Labor of the Russian Federation ofJanuary 24, 2014 No. 33n Methodology for conducting a special assessment of working conditions; SanPiN 2.2.4.3359-16 Sanitary and epidemiological requirements for physical factors in the workplace). Calculation of indicators of risk of loss to health in accordance with GOST R 12.0.010-2009 “SSBT SUOT hazard identification and risk assessment”, methodological recommendations “Assessment and forecast of professional reliability and professional risk of drivers of various vehicles” MR 2.2.0085-14, taking into account the requirements of the Manual of 24.06.2003 № 2.2.1766-03 Manual for assessing professional risk to the health of employees. Organizational and methodological bases, principles and evaluation criteria.

Results. Based on the risk assessment methodology, regression formulas were developed for predicting the health loss of locomotive crew drivers and age groups were identified with a high degree of probability of their production-related and occupational pathology.

Conclusions. The working conditions of drivers of locomotive crews were assessed as harmful to the second degree (3.2). The main adverse factors are noise, general vibration, microclimatic conditions, stress and severity of the labor process. The risk of loss of health calculated in accordance with GOSTR 12.0.010-2009 is defined as “High” (R=10.7). The critical age of 50years has been established for the formation of production-related pathology of the nervous and cardiovascular systems. There is a high probability of manifestation of the initial phenomena of sensorineural hearing loss at the turn of 40 years, at the age of 52-55 years (work experience of 27-30 years) — professional sensorineural hearing loss. A high probability of professional pathology formation by the age of 55 was revealed. It is justified to reduce the working shift to 6 hours (30 hours per week) or provide an additional day per week (32 hours per week).

Brucellosis is a zoonotic infectious disease transmitted from sick animals to humans, characterized by multiple lesions of the body’s organs and systems. Officially registered incidence of brucellosis in Russia is low-0.3-0.4 per 100 thousand population. However, these figures may be much higher, since only newly detected cases are subject to registration, and there is no record of chronic forms and residual phenomena.

The results of a correspondence retrospective examination of medical documents and radiographs of 11 patients with a previously established diagnosis of residual brucellosis are presented. Patients worked in the livestock industry in different professions in one of the republics of the Russian Federation.

Pathognomonic changes of the bone and joint system in the form of sacroiliitis were detected in 55% of patients, spondylitis-in 64%, and lesions of the clavicular-acromial joints-in 63%. Lesions of large joints — hip and knee-were characterized by pronounced deforming arthrosis with relative preservation of small joints. Osteoporosis was detected in 82% of cases.

The detected radiological changes in the musculoskeletal system do not allow us to fully justify the presence or absence of a diagnosis. The main diagnostic criteria are the features of the epidemiological history and the results of laboratory diagnostics.

Inhaled bronchiolitis develops from exposure to gases, vapors, acids, fumes and other substances and is characterized by a progressive course. Therapy of inhaled bronchiolitis is not fully presented to date. The results of long — term follow-up of 11 patients with chronic inhaled bronchiolitis from exposure to harmful factors (3 men, 8 women 49.2±2.1 years), 18% — smokers were analyzed. A comprehensive functional study of external respiration and lung diffusion capacity (LDC) and high-resolution computed tomography (HRCT) were performed before and after 1.7±0.4 years of treatment. The diagnosis was made using a 2.6±1.2 years after the appearance of the first symptoms of bronchiolitis. Eight patients received nebulizer therapy with budesonide 1000 mcg per day for two weeks in combination with inhaled glucocorticosteroids, long-acting beta2-agonists and long-acting anticholinergic drugs in ultradisperse forms via dosed inhalers. Three patients took bronchodilators according to their needs.

Against the background of therapy, all patients showed stabilization of the course of the disease. Prior to treatment, HRCT revealed a mosaic of the pulmonary pattern (75%; 6/8), centriacinar foci and bronchioloectases — the pattern “tree in the buds” (50%; 4/8), “air traps” (80%; 4/5). After therapy, positive CT dynamics was determined in the form of a decrease in the uneven density of lung tissue and the disappearance of the “tree in the buds” pattern in 5 patients (62%). In three patients who did not follow the recommendations, CT changes remained: the mosaic of the lung pattern and “air traps” were detected in 67% (2/3) of cases, the pattern “tree in the buds” — in one patient 33% (1/3). Indicators of external respiration changed according to the obstructive type. After treatment, there was a tendency to reduce hyperinflation-residual lung volume (RLV) decreased by 40.7%, although it remained elevated in 66.7% (4/6) patients. LDC increased by 6.6% and normalized in 2 patients.

Conclusions. For the diagnosis of inhalation bronchiolitis is recommended to body plethysmography, LDC test and HRCT. Long-term triple therapy leads to stabilization of the course of the disease, reduction of hyperinflation, reduction of CT signs of bronchiolitis. To control the course of bronchiolitis, it is advisable to monitor the RLV and LDC, HRCT picture with the study on inhalation and exhalation.

In recent years, there have been regular cases of employers and insurers refusing to fulfill their obligations to an employee affected by an occupational disease using incorrect methods of challenging the established diagnosis of an occupational disease.

We analyzed pre-trial disputes and court cases in which an employer or insurer tried to avoid fulfilling their obligations to an employee affected by an occupational disease by declaring such a diagnosis unfounded without its official cancellation. The general pattern of incorrect actions by employers or insurers is stereotypical. At first, they refuse to fulfill their obligations to the sick employee on the basis of a declaration of their belief in the absence of professional pathology. If an employee tries to protect their interests in court, the employer or insurer disputes the diagnosis of an occupational disease, using various tricks to avoid objective consideration of the circumstances of the previously conducted examination of the connection of the disease with the profession.

To stop the above-described practice, it is necessary to reform the legal framework in the field of accounting and investigation of occupational diseases. The procedure for considering disagreements in the field of occupational pathology diagnostics should be clearly regulated.

Introduction. There are few publications analyzing the specifics of rehabilitation measures for medical workers (MW) affected by occupational diseases (OD). This circumstance makes it relevant in the Russian Federation to research on the problems of assessing the quality and improving the effectiveness of rehabilitation of MW who were injured as a result of OD.

The aim of the study is to determine the specifics of medical and professional rehabilitation of medical workers with OD and to determine ways to improve the rehabilitation of this contingent.

Materials and methods. According to archival materials of the centers of occupational pathology and the bureau of medico-social examination of the North-West Federal district of the Russian Federation for the period 2000-2017 the documentation was analyzed for 225 MW affected by OD, evaluated the data to determine the degree of disability and of disability, the dynamics of the health status of patients in process of rehabilitation, assessed the availability of medical assistance and sanatorium-resort therapy for these patients.

Results. Rehabilitation measures were carried out for MW with infectious, allergic, and physical overload-related diseases. Most patients could continue working in healthcare if their working conditions changed. However, employment of MW in conditions that exclude the impact of harmful production factors that are contraindicated by them was carried out only in isolated cases. The need for medical rehabilitation measures was determined by only 75% of MW with OD, of which 73% of patients were provided with medication, and 12% with Spa treatment. In dynamic follow-up, a positive dynamic during OD was observed in 22.5% of patients.

Despite the onset of epidemic stabilization of tuberculosis in Russia in recent years, the situation is still extremely unfavorable. Diagnosis of the disease at a late stage, untimely treatment lead to a deterioration in the prognosis of survival of patients. As you know, silicosis is often complicated by the addition of tuberculosis infection, while there is still no clear idea about late silicotuberculosis, as well as the generally accepted classification.

The aim of the study was to explore the incidence of tuberculosis in patients with late silicosis.

Over the years, 172 patients with suspected silicosis have been monitored. A group of 38 people who developed late silicosis was selected from them. Patients worked in professions where silicosis most often develops from inhaling dust containing free silicon dioxide more than 10%, with a work experience of 6 to 15 years.

The analysis of the data obtained showed that tuberculosis infection joins after 4-12 years in patients with late silicosis in almost 40% of cases. Patients with mixed pathology rarely secrete Mycobacterium tuberculosis.

New trends in the organization and implementation of state quality control and safety of medical activities in combination with the functioning of the internal quality control system are considered.

The analysis of normative legal acts regulating the quality control of medical activities in the field of occupational pathology, as well as data from a sociological survey (questionnaire) of representatives of Federal Executive authorities in the field of health and medical organizations to study the role of Supervisory authorities in the prevention of diseases.