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Федеральное государственное бюджетное образовательное учреждение высшего образования «Московский государственный медико-стоматологический университет имени А.И. Евдокимова» Министерства здравоохранения Российской Федерации, 127473, г. Москва, Российская Федерация 2 Центральная дирекция здравоохранения -филиал ОАО «РЖД», 123557, г. Москва, Российская Федерация

Aim. To analyze factors that potentially influencing the incidence of members of locomotive crews.Material and methods. The survey method was used to survey 10476 members of locomotive crews. Overall 9309 individuals were included in the analysis. The study was conducted on all railways of the Russian Federation (63 subjects of the Russian Federation). The questionnaire included: the passport part, the results of medical research (blood pressure, cholesterol and blood glucose levels), questions on workrelated risk factors, risk factors for chronic non-infectious diseases, questions reflecting the subjective opinion of member on the problem.Results. The incidence of locomotive crews members is associated (p<0,05) with the place of work, the types of rolling stock and traffic. By type of traffic, the highest incidence was observed in the members of goods trains; by type of rolling stock, the lowest incidence was among engine drivers and their assistants. The number of cases of diseases with temporary disability over the past year has been associated with rank held. Persons who have experienced temporary disability, are characterized by: 1,2 times lower daily consumption of fruits and vegetables, 1,1 times higher value of BMI and waist circumference, and 1,03 higher blood cholesterol level.Conclusion. The results show that preventive programs can be effective in reducing the incidence of locomotive crews members.

Purpose: to analyze causes of sudden death (SD) of workers of locomotive crews. Materials and methods. We performed the retrospective analysis of SDs of employees of Joint Stock Company ( JSC) “Russian Railways” for the period 2009–2017 (total 119 cases). Results. As a rule, the combination of risk factors of development of cardiovascular diseases was present, but the SCORE scale risk of cardiac death was average. However, in 60 % of cases at life risks were not correctly assessed. Differences were found between the deceased depending on what type of locomotive they steered. Also, a part of SD victims overworked during the last month (year). Conclusion. Further improvement of work of medical service of JSC “Russian Railways” is necessary.

Purpose: studying of efficiency of medical support of the workers of locomotive crews (WLC) on decrease in the incidence connected with temporary disability.Materials and methods. Data on five-year incidence (2013-2017) of WLC and costs of JSC "Russian Railways" of their medical maintenance are used. Calculations of the economic losses connected with temporary disability of WLC are executed.Results. The health service of JSC “Russian Railways” works effectively. About 5.9 billion rubles/year are spent for its contents. Due to decrease in the average duration of one case connected with temporary disability, the health service allows to save JSC “Russian Railways” to 5.3 billion rubles annually. Calculation shows that at reduction of a difference in the average duration of one case of temporary disability in JSC “Russian Railways” and one case of temporary disability for men of working-age of the all-Russian level up to 1.7±0.2 days, the health service can become inefficient from economic positions.Conclusions. From the economic point of view, the health service of JSC “Russian Railways” is justified at an essential difference in duration of one case of temporary disability for WLC and temporary disability of the all-Russian level for similar gender and age group.

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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.