Introduction. The Russian Federation has certain socio-demographic and geographical features that make it difficult to provide qualified medical care to the population. The relevance of telemedicine in modern conditions is difficult to overestimate. Telecommunications technologies have significant potential to address the challenges of providing affordable, cost-effective and high-quality health services to the population. Telemedicine uses information and communication technologies to overcome geographical barriers and increase public access to health services. On May 9, 2017, the President of the Russian Federation approved the "Strategy for the development of the information society in the Russian Federation for 2017-2030" by decree № 203. Digital healthcare is an integral part of the digital economy.

The aim of study is to analyze the regulatory framework for telemedicine support of occupational pathology activities.

Materials and methods. The analysis of the development of telemedicine technologies in the Russian Federation is carried out. The legal framework regulating the work of a professional pathologist using telemedicine technologies has been studied.

Results. Consultation of the patient or his legal representative by the medical officer are prevention, collection, analysis of the patient's complaints and data of anamnesis, evaluation of the efficiency of diagnostic and therapeutic activities, medical monitoring of patient's condition and decision on the need for face-to-face reception (examination, consultation). The implementation of these measures using telemedicine technologies is regulated by article 36.2 of Federal Law № 323-FZ, which states that remote monitoring of the patient's health and correction of previously prescribed treatment by the attending physician can be carried out after an in-person appointment (examination, consultation).

Remote surveillance is carried out on the basis of data about the patient, was with the use of medical devices intended for monitoring human body, and/or on the basis of the data entered into the unified state information system in health care, or public information system in healthcare of the Russian Federation, or medical information system or information system referred to in part 5 of article 91 of the Federal Law № 323-FZ in compliance with, established by the legislation of the Russian Federation in the field of personal data, and compliance with medical confidentiality.

Conclusions. It is necessary to implement telemedicine technologies for pre-hospital consultation of patients to clarify the preliminary diagnosis, methods of examination and treatment, and advice on patient management tactics in the long-term period of the disease. The question of using technologies for patient consultation in the "patient-doctor" system remains open due to the peculiarities of diagnostic and expert work of professional pathologists, which requires the analysis of a large number of documents provided by various departments (medical organizations of different forms of ownership, the office of Rospotrebnadzor, Medical and Social Expertise (MSE), employer, etc.).

Introduction. The working conditions of pharmaceutical industry workers are characterized by the combined effect of unfavorable factors of the production environment, among which the leading one is chemical.

The aim of study is to substantiate the basic principles and criteria for hygienic regulation of pharmaceutical products in their production to ensure safe working conditions for employees based on the results of their own research and existing requirements of technical regulations.

Materials and methods. Analysis of working conditions and the prevalence of health disorders in pharmaceutical workers (according to literature data), toxicological studies of pharmaceutical substances on laboratory animals, scientific justification of hygiene standards in the air of the working area.

Results. Among employees of the pharmaceutical industry, the predominant forms of production-related health disorders are diseases of the respiratory system, as well as skin dermatitis of allergic origin, liver and biliary tract diseases. Based on the results of experimental studies of domestic pharmaceutical products for the treatment of cardiovascular, oncological and mental diseases that have priority socio-economic significance, the basic principles and features of the practice of justifying the hygienic standards of medicines in the air of the working area are developed and systematized.

Conclusions. During hygienic rationing of medicines, it is necessary to use a differentiated approach that allows, based on the analysis of information about the chemical structure, physical and chemical characteristics, production conditions, pharmacotherapeutic activity, and the results of studying the toxic effect in an experiment on laboratory animals, to determine the maximum permissible content in the air of the working area of medicines or to justify the prohibition of isolation with reasoned recommendations for their safe production.

Introduction. Before the entry into force of the Federal law of the Russian Federation of December 28, 2013 No. 426-FZ "On special assessment of working conditions" one of the available and effective elements of occupational risk assessment in the workplace was workplace certification (WPC) for working conditions, which allows to identify harmful and/or dangerous factors of the production environment, assess the risk levels in the workplace and determine the main areas of employee protection from the adverse effects of harmful production factors. The results of a special assessment of working conditions (SAWC) can be used not only to develop and implement measures aimed at improving the working conditions of employees, informing employees about working conditions and the existing risk of damage to their health, but also to establish guarantees and compensation provided for by the Labor code of the Russian Federation (RF) for employees engaged in work with harmful and (or) dangerous working conditions.

The aim of the study is to identify problematic issues during the implementation of SAWC at the workplaces of medical workers to prevent possible errors in its further implementation.

Materials and methods. We used data obtained from the results of WPC and SAWC of medical workers of various medical organizations of the Republic of Tatarstan (RT). A retrospective analysis of cases of occupational diseases was applied according to the data of the Department of Rospotrebnadzor for the Republic of Tatarstan and the register of patients of the Republican Center of Occupational Pathology.

Results. In the RT medical organizations according to the results of SAWC marked decrease in the number of jobs with hazardous working conditions from 92.2% to 78.2% due to the fact that the methodology of the SAWC will not assess the intensity of the work process in all workplaces health workers, and identification and evaluation of biological factors do not always reflect the actual microbiological status of the environment. As a result, working conditions are assessed as acceptable, which deprives medical workers of previously established guarantees and compensation. In addition, during periodic medical examinations (PME), studies on the biological factor are not fully carried out, which makes it difficult to diagnose viral hepatitis, which occupies the second place in the structure of occupational morbidity of medical workers.

Conclusions. For high-quality implementation of SAWC in medical organizations, it is necessary to assess the intensity of the labor process of medical workers, taking into account intellectual, sensory, emotional loads, monotony of loads and working hours, and for the correct assessment of the biological factor, it is recommended to introduce an epidemiologist to the commission.

Introduction. Digital technologies are actively used in the work of specialists of medical centers of various profiles, which causes the impact on employees of a number of professional factors that determine the characteristics of their work.

The aim of the study is to evaluate the influence of professional factors on the functional state of the employees' body and the glutathione system as an objective indicator of stress based on the analysis of the subjective perception of the medical center employees of the specifics of working with personal computers and psychophysiological testing.

Materials and methods. The study involved 109 specialists of medical centers (25 ophthalmologists, 31 representatives of the secondary medical staff - nurses and paramedics, 53 office employees). The anonymous survey concerned the assessment of working conditions and their impact on the functional state of the body of the respondents. Performance and stress tolerance indicators were evaluated using three standard questionnaires. The study of 66 subjects' levels of glutathione in the blood: total, reduced, oxidized and the ratio of reduced and oxidized - was used to analyze the relationship of the neuro-emotional nature of labor with the reaction of oxidative stress. Statistical processing of the obtained data was carried out using traditional methods of variation statistics and calculating the value of the odds ratio (OR) with a 95% confidence interval (CI).

Results. The survey revealed a significant proportion of people in all groups of respondents who constantly use computer technology in their work. Describing the quality of the processed information, doctors more than representatives of other groups note its complexity, importance, negative emotional color, a high degree of responsibility and tension. Doctors more often than average medical staff and office workers associate the manifestation of fatigue with an uncomfortable state of the visual organ, nervous system, and musculoskeletal system. The subjects showed reduced performance and stress tolerance with the most pronounced negative trends in the group of doctors. Changes in the glutathione system were detected, indicating the presence of oxidative stress in 40% of ophthalmologists and office workers, and in half of nurses.

Conclusions. The work of specialists of medical centers of various profiles in accordance with their assessment is characterized by high nervous and emotional stress, due to the need to process a significant amount of complex and important professionally significant information. Subjectively noted by respondents the influence of working conditions on the functional state of the body is confirmed by indicators of the glutathione system, which can be used as indicators of nervous and emotional stress.

Firefighters are exposed to factors that can cause acute and chronic health problems and have long-term health effects. The study aim is to review and analyse publications by authors from Russia and abroad devoted to firefighting and health impacts of different risk factors.

The authors analysed studies published on MedLine, PubMed, Elibrary.ru and Cyberleninka with data on working conditions, risk factors and health impacts for firefighters spanning different categories: those who work in cities, forest firefighters, and volunteers. The authors used statistical research methods for this analysis.

Findings of the studies by Russian and foreign authors were used to analyse working conditions of firefighters, as well as trends, morbidity patterns and causes of newly diagnosed disabilities, and firefighter mortality compared to population of comparable age in Russia and other countries. The authors performed comparative analysis of risks of some diseases in firefighters and mortality caused by them. The authors found that respiratory diseases account for the largest cause of morbidity in firefighters in the area under analysis. Respiratory disease and musculoskeletal disorder risks are RR=2.8 (EF=65%) and RR=2.1 (EF=53%), respectively. Respiratory and circulatory system diseases are work-related diseases. Circulatory system diseases are the largest cause of inpatient care morbidity and disability in firefighters. According to several studies, cancer morbidity and mortality in firefighters has been increasing. Some studies say that the cancer mortality rate is higher in firefighters than in peer population, although others have not found such differences.

Firefighters are exposed to occupational hazards and dangers, as well as to considerable psychological stress. Rates of disability caused by sensory system conditions, circulatory system diseases and digestive diseases are higher in EMERCOM of Russia’s firefighters than in other population groups. No relationship has been found between occupational risk factors and cancer morbidity in firefighters. Such a relationship can be confirmed only as a result of epidemiological studies.

A review of 47 studies evaluating the occurrence of metabolic syndrome among employees of different professional groups around the world was made. The influence of various factors of the professional environment (physical activity in the workplace, exposure to occupational stress, exposure to harmful toxicants) on the frequency of the syndrome and its components, considering gender, age and work experience. Analysis of the literature has shown that the characteristics of work activity affect the formation of the syndrome along with well - known risk factors-lifestyle, gender and age. Thus, in most cases, the frequency of metabolic syndrome in people who have mostly "sedentary" work is much higher than in other professional groups. It is proved that the risk of the syndrome is increased when exposed to certain chemicals that are in the air of the work area, even in small concentrations, as well as under unfavorable conditions of activity - shift work, night duty, professional stress. To improve the quality of life of employees and reduce economic and social costs, it is necessary to develop programs for the prevention and rehabilitation of people with this pathology, taking into account specific working conditions, while making adjustments for gender, age, social factors (smoking status, alcohol consumption, eating behavior, physical activity during and outside of work).

Currently, the problem of reducing the risk of developing fat liver hepatosis from exposure to household and industrial toxicants among the working-age population continues to be an important medical and social problem, since not timely diagnosis of the disease can lead to its progressive course with the development of inflammatory changes, necrosis and liver fibrosis up to cirrhosis and hepatocellular cancer. In this regard, the search for methods and techniques that optimize the diagnosis of fat hepatosis is relevant. Modern methods of radiation diagnostics of liver density characteristics can significantly reduce subjectivity in the assessment of changes due to the use of quantitative indicators.

The aim of study - improving the quality of x-ray diagnostics of fat liver disease based on a precision assessment of the density of the liver parenchyma using computed tomography.

A comparative retrospective analysis of the results of a comprehensive clinical and radiological examination of 115 men of working age in the range of 40-55 years was performed. The main group (48 people) - employees of machine-building plants: shapers, stumpers, fitters-assemblers who had industrial contact with such factors as local vibration, dust, noise, muscle strain, burdened with a long alcoholic history and the presence of signs of metabolic syndrome: hyperlipidemia, impaired tolerance to carbohydrates, diabetes, abdominal obesity. The comparison group included representatives of auxiliary professions without clinical signs of pathology (47 people), comparable in age and experience with the main group. X-ray examinations were performed using computer tomographs: "HI Spead CT/e Dual" by GE Medical Systems and "Aqulion 64" by Toshiba. To measure the liver density in Hounsfield units (HU), the ROI (zone of interest) tool was used, which allows determining the desired value over areas of different dimensions. Measurements were performed on computer screens in 4 zones of interest at 4 levels of scanning of the liver lobes (apex, level of the caval gate, level of the left lobe, level of the portal gate) with the calculation of the average values of the density index (IDH) and density gradients (IDG) relative to the aorta, spleen and kidney.

Analysis of the results of a posteriori CT densitometry of various parts of the liver within the framework of the developed algorithm, including the use of absolute and relative (gradient) x-ray density indicators of hepatic, vascular (aorta),splenic and renal structures, allowed us to expand our understanding of the quantitative density characteristics both in normal and in patients with signs of diffuse fat hepatosis (FH). It was found that the liver parenchyma density indicators can be a kind of (conditional), sometimes the only indicators of the degree of severity of changes that objectively manifest positive or negative dynamics of pathophysiological processes and, in particular, at the initial stages of the development of the studied pathology. Density differences in the right and left liver parenchyma in the control group (conditional norm) in terms of absolute density and its gradient, regardless of the level of scanning, were insignificant (statistically unreliable). In patients with clinical signs of fatty liver infiltration at the stage of steatosis, in the absence of x-ray morphologically detectable structural changes, a decrease in IDH and the dynamics of its increase (recovery) at various stages of observation were revealed. Even with comparatively equal IDH of the evaluated departments, the IDG of different people differed, manifesting the individuality of metabolic processes occurring in the body, in particular in the liver, is a kind of indicator of their direction and severity. The significance of density indicators as predictors of the subsequent stages of the pathology under consideration was particularly evident in the analysis of the results of primary diagnostics and its development in the dynamics of observations.

The application of the developed methodological approach allowed us to expand our understanding of the possibilities of KT-liver densitometry in patients with metabolic syndrome (hyperlipidemia, impaired carbohydrate tolerance, diabetes mellitus, abdominal obesity) in the diagnosis of fatty liver disease (FLD) at various stages of examination, including in the early subclinical phases of pathology development. The results obtained indicate the predominant role of ethyl alcohol as a hepatotoxicant in the development of FLD in the estimated cohort of the working-age population. The use of an original algorithm for evaluating tissue density makes it possible to significantly ensure the objectivity of the interpretation of research results.

The susceptibility to the development and progression of inflammatory periodontal diseases, which depends on genetic and external factors (smoking, stress, oral hygiene), varies widely. In the development of these diseases, an important role is played not only by the presence of periodontal pathogenic microorganisms, but also by the presence of congenital or acquired immunodeficiency, immunoregulatory defects.

The immune system plays a key role in the physiological and pathological processes of periodontal tissues. In this regard, IL17, produced by CD4+ Th cells, which has both Pro-inflammatory and protective activity, is of particular interest in the pathogenesis of periodontitis.

The aim of study was to identify the relationship between polymorphic loci of the IL-17A (rs2275913) and MMP-1 (rs1799750) genes and clinical manifestations of chronic periodontitis in petrochemical workers.

Dental examination was performed in 92 ethylene oxide production workers with chronic periodontitis and 74 patients with chronic periodontitis who did not come into contact with chemical factors (control group). Genotyping of polymorphisms rs2275913 of the IL17A gene and rs1799750 of the MMP1 gene was performed by allele-specific real-time polymerase chain reaction (PCR). Hygienic assessment of the degree of air pollution of the working area with harmful substances was carried out by gas chromatography according to the guidelines for the determination of harmful substances in the air № 5098-89, № 3119-84.

When comparing the results of studies of both groups, there were no statistically significant differences in the frequency distributions of allelic variants and genotypes of the IL-17A and MMP-1 genes. The AA/AG genotypes of the IL-17A gene were associated with an increased risk of severe disease compared to the GG genotype in workers in the main group (OR=6.1; 95% CI 1.33-28.5; p=0.021) and in the control group (OR=7.26; 95% CI 1.34-39.25; p=0.016). Carriers of the A allele in the control group increased the risk of severe chronic periodontitis by 2.4 times compared to carriers of the G allele (OR=2.41; 95% CI 1.19-4.87; p=0.014).

During the dental examination of employees of the ethylene oxide plant, the clinical course of periodontal diseases was more severe in comparison with the control group, and the number of patients with severe periodontitis was twice as high. It was found that the AA/AG genotypes of the IL-17A gene and the carrier of the A allele are associated with increased susceptibility to the development of severe chronic periodontitis. The association between the MMP-1 gene polymorphism and the risk of severe forms of chronic periodontitis has not been established. A risk factor for the development of inflammatory periodontal diseases in employees of the petrochemical complex is a complex of harmful production factors.

Preserving the working longevity of locomotive crew employees is one of the priority tasks of Russian Railways. The urgency of the problem is related to both the medical aspects of railway traffic safety and the importance of preserving human capital.

The aim of study is to research the influence of occupational and behavioral risk factors on health disorders in drivers and their assistants.

The study included the results of a survey of 9308 employees of locomotive crews on the presence of production and behavioral risk factors for health disorders, as well as on the presence of cases of temporary disability, hospitalization or unscheduled medical care in the previous year. Additionally, the results of clinical and laboratory studies were studied.

Noise exposure is the main production factor affecting the unscheduled attendance of locomotive crew employees to the doctor, the number of cases of temporary disability and hospitalization. Only 13% of respondents have a high level of commitment to a healthy lifestyle. Among employees who are not exposed to industrial noise, the number of people who have a high commitment to a healthy lifestyle is 2 times higher than among those who complain about the presence of an acoustic factor. The main differences in adherence to a healthy lifestyle between people who have and do not have complaints about the negative impact of the sound factor are related to alcohol abuse (1.4 times more often used by people working in conditions of noise exposure), frequent use of semi-finished products and fatty foods (1.2 times more often). Among people exposed to industrial noise, a body mass index (BMI) exceeding 25 kg/m² is 1.5 times more common than in people who do not have noise exposure. The frequency of occurrence of blood pressure is more than 130/80 mm Hg. and blood cholesterol more than 5 mmol/l, respectively, is 1.9 and 2.2 times higher in individuals with intra-cab acoustic load, compared with those without. An increase in the number of cases of temporary disability, hospitalization, and unscheduled visits to a doctor in people who report exposure to noise in the driver's cab may be associated with both occupational and behavioral factors: alcohol consumption, poor nutrition, and a high proportion of people with a BMI exceeding 25 kg/m².