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.
Pancreatic cancer (PC) is one of the most fatal types of oncological disease in the world and is an extremely aggressive cancer with a poor prognosis. The objective of this review was to analyze the domestic data of the incidence of PC in the Russian Federation and to analyze the protocols that are used for the management of this group of patients in Russian clinical centers. For the analysis of the literature sources, the data in the elibrary.ru database published in the period from 2015 to 2019 were used. The methodology that was used in each study was examined in order to ensure its reliability, and these data were selected as potential sources of evidence for the preparation of national recommendations. The study results influence the level of evidence assigned to the publication. Updates to the national recommendations are conducted at least once every three years, and these updates depend on new information about the diagnosis and management of patients with PC.
Introduction. Occupational interstitial lung diseases (ILD) include exogenous allergic alveolitis (EAA), exogenous toxic alveolitis (ETA), pneumoconiosis. The scientists have established the fact of exposure to external factors in 35% of patients with ILD. We have confirmed the association of the disease with the profession in 10% of cases. The study aims to assess the prevalence and clarify the reasons for the unsatisfactory diagnosis of occupational diseases (ILD) in Russia. Materials and methods. The researchers have conducted the analysis of officially registered occupational morbidity in the Russian Federation and the North-Western Federal District (NWFD) for 2018-2020 and the study of the effectiveness of the examination of the connection of the disease with the profession in case of suspected occupational disease in 121 patients with an established diagnosis of EAA. Results. We have established that among the occupational diseases ILD first identified in the Russian Federation in 2020, pneumoconiosis occupied the leading place - 92.7%, of which a third of cases (34.6%) were silicosis. Coniotuberculosis was in 0.8% of cases, EAA - in 6% of cases, while in 9 patients (4%) the diagnosis was as "EAA", and in 5 patients (2%) - as "Hypersensitive pneumonitis". Toxic pneumosclerosis was 0.4%. In the NWFD, experts have registered all occupational diseases of the respiratory system: ILD - 18.5% (2018), 8.6% (2019), in 20.4% of cases (2020), of which pneumoconiosis took the leading place. There were only 3 cases of exogenous alveolitis. The researchers have analyzed the reasons of insufficient registration of professional exogenous alveolites. The low detectability of professional exogenous alveolitis is due to both the insufficient commitment of patients to the establishment of an occupational disease, and the poor quality of periodic medical examinations of employees due to the concealment of complaints by patients, the use of low-informative fluorography, incorrect interpretation of the results of the examination. Conclusion. Thus, among occupational ILDs, pneumoconiosis was on the leading position. Incomplete registration of cases of occupational exogenous alveolitis is due to insufficient diagnosis, terminological inconsistency in the designation of EAA and ETA, inadequate coding of ETA from exposure of industrial chemical factors. Ethics. This study did not require the conclusion of the Ethics committee.
Abstract. All management decisions in the healthcare are based on reliable data from medical accounting and reporting. Aim. Improve reporting forms in order to optimize accounting and reporting. Materials and methods. One of the main statistical forms of medical reporting that makes it possible to analyze indicators of the health status of workers and the activities of medical organizations in occupational medicine in the Russian Federation is the Form No. 30 “Information about a medical organization”. Results. The indicators analysis of the activities of medical organizations in the Russian Federation providing occupational health care was carried out on the basis of the Form No. 30 “Information about a medical organization”. The reporting forms about the examinations of occupational suitability and examinations of the connection between the disease and the occupation in the Russian Federation have been also developed and improved. The data analysis of medical organizations in the system for accounting and analyzing of occupational diseases «Occupational medicine» posted on the web-site http://profstat-irioh.ru is also carried out. Conclusion. It is proposed to improve the reporting documentation in order to optimize accounting and reporting if necessary. It is also proposed to keep statistics on the mandatory preliminary and periodic medical examinations for workers employed in jobs with harmful and (or) hazardous working conditions in the federal statistical form No. 1-zdrav “Information about the health care organizations”.
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