BackgroundThe disasters at Seveso, Three Mile Island, Bhopal, Chernobyl, the World Trade Center (WTC) and Fukushima had historic health and economic sequelae for large populations of workers, responders and community members.MethodsComparative data from these events were collected to derive indications for future preparedness. Information from the primary sources and a literature review addressed: i) exposure assessment; ii) exposed populations; iii) health surveillance; iv) follow-up and research outputs; v) observed physical and mental health effects; vi) treatment and benefits; and vii) outreach activities.ResultsExposure assessment was conducted in Seveso, Chernobyl and Fukushima, although none benefited from a timely or systematic strategy, yielding immediate and sequential measurements after the disaster. Identification of exposed subjects was overall underestimated. Health surveillance, treatment and follow-up research were implemented in Seveso, Chernobyl, Fukushima, and at the WTC, mostly focusing on the workers and responders, and to a lesser extent on residents. Exposure-related physical and mental health consequences were identified, indicating the need for a long-term health care of the affected populations. Fukushima has generated the largest scientific output so far, followed by the WTCHP and Chernobyl. Benefits programs and active outreach figured prominently in only the WTC Health Program. The analysis of these programs yielded the following lessons: 1) Know who was there; 2) Have public health input to the disaster response; 3) Collect health and needs data rapidly; 4) Take care of the affected; 5) Emergency preparedness; 6) Data driven, needs assessment, advocacy.ConclusionsGiven the long-lasting health consequences of natural and man-made disasters, health surveillance and treatment programs are critical for management of health conditions, and emergency preparedness plans are needed to prevent or minimize the impact of future threats.
The aim of this paper was to ascertain chronic obstructive pulmonary disease (COPD) prevalence among industrial workers in the Russian Federation and determine relative contribution of smoking and occupational factors to COPD. We recruited 1,375 workers aged 30 or over. Six hundred and twenty-four of them were occupationally exposed to vapours, gases, dust, and fumes (VGDF). Physical examination and baseline spirometry were performed for all the participants of the study. Those with airfl ow limitation of FEV 1 /FVC<0.70 were considered having COPD and those with presence of cough and sputum production for at least three months in each of two consecutive years were considered having chronic bronchitis (CB), with no overlapping between these 2 groups. Data on occupational history and VGDF levels in the working area were collected from all participants. In total, 105 cases of COPD and 170 cases of CB were diagnosed in the cohort of examined workers. Occupational exposure to VGDF was twice as often present among COPD patients than among both patients with CB and the control group of healthy workers (p<0.05). More than 40 % of COPD patients were occupationally exposed to VGDF above the value of 3.0 of the occupational exposure limit (OEL) and more than 20 % to 6.0 OEL and higher. Overall odds ratio for COPD development due to occupational VGDF exposure was 5.9 (95 % CI=3.6 to 9.8, p=0.0001). Both smoking and VGDF seem to be important for the development of COPD. Analysis of the combined effect of tobacco smoking and occupational noxious particles and gases on COPD development has shown the following order of risk factors based on the strength of their infl uence: VGDF levels, smoking index, age, and heating microclimate. There is a statistically signifi cant level of relationship and "dose-effect" dependence between occupational exposures to VGDF and the development of COPD. The effect of VGDF composition on the probability of COPD development was not found in the study. Results of this study were used to substantiate the inclusion of COPD into the National List of Occupational Diseases of the Russian Federation.
Клинические рекомендации Методы, использованные для сбора / селекции доказательств: поиск в электронных базах данных Описание методов, использованных для сбора / селекции доказательств: доказательной базой для рекомендаций являются публикации, вошедшие в Кокрановскую библиотеку, базы данных Embase и Medline. Глубина поиска составила 5 лет. Методы, использованные для оценки качества и силы доказательств: • консенсус экспертов; • оценка значимости в соответствии с рейтинговой схемой (табл. 1). Методы, использованные для анализа доказательств: • обзоры опубликованных метаанализов; • систематические обзоры с таблицами доказательств. Описание методов, использованных для анализа доказательств. При отборе публикаций как потенциальных источников доказательств использованная в каж
АДЕНИНСКАЯ ЕЛЕНА ЕВГЕНЬЕВНА, канд. мед. наук, руководитель научно-исследовательского Центра профпатологии и гигиены труда гражданской авиации ФБУ «Центральная клиническая больница гражданской авиации», Россия, 125367, Москва, Иваньковское шоссе, 7, тел. +7-916-845-50-45, e-mail: loruna@gmail Реферат. Потеря слуха, вызванная шумом, является самым диагностируемым профессиональным заболева-нием не только в Российской Федерации, но и в странах Европейского союза, США в других государствах, и составляет от 7 до 12% всех выявляемых случаев тугоухости различного генеза. При этом подходы к оценке производственного шума, представления о влиянии его на орган слуха работников и методология оценки величины профессионального риска, принятые в глобальном сообществе профпатологов и специалистов по медицине труда, до сих пор не нашли широкого применения в России. Цель -провести систематический обзор доказательных данных отечественной литературы, касающихся принципов диагностики и экспертизы связи про-фессии и потери слуха, вызванной шумом. Материал и методы. Проведен обзор рецензируемых публикаций отечественных авторов, имеющих российский индекс научного цитирования. Результаты и их обсуждение. Абсолютное большинство отечественных научных публикаций в области анализа влияния шума на орган слуха характеризуется недостаточной степенью доказательности, что существенно затрудняет возможность прове-дения их сравнительного анализа с результатами зарубежных исследователей. Выводы. Наличие различных методических подходов и классификаций степени выраженности нарушений органа слуха при потере слуха, вызванной шумом, затрудняет междисциплинарные взаимодействия врачей и требует действий по внедрению в практику Федеральных клинических рекомендаций по диагностике, лечению и профилактике потери слуха, вызванной шумом. Ключевые слова: сенсоневральная тугоухость, нейросенсорная тугоухость, профессиональная тугоухость, производственный шум. Aviation, Russia, 125367, Moscow, Ivankovsk highway, 7, tel. +7-916-845-50-45, e-mail: loruna@gmail Medicine, Russia, 105275, Moscow, Budyonnyi ave., 31 Abstract. Noise-induced hearing loss is the most diagnosed occupational disease not only in the Russian Federation, but also in the countries of European Union, United States and others; ranging from 7 to 12% of all detected cases of hearing loss of different origin. At the same time, the approaches to industrial noise measurement, the views on its effect on the ear of the workers and the methodology of occupational risk evaluation, accepted by the global community of pathologists and specialists in occupational medicine, has still not found wide application in Russia. Aim. Systematic review of native papers on the principles of diagnosis of noise-induced hearing loss and its recognition as an occupational disease was performed. Material and methods. Study of peer-reviewed publications of Russian authors was made. THE PRINCIPLES OF NOISE INDUCED HEARING LOSS DIAGNOSTICS IN MODERN RUSSIA (systematic review) ADENINSKAYA ELENA E., C. Med. Sci., Head of Rese...
An in-depth analysis conducted on the historical background and current status of occupational medicine in Russia is presented. Scientific and practical bases of occupational medicine in the Russian Federation were based on 2 of the most important principles of health service: free medical care and its preventive orientation. Our analysis of the current situation in occupational medicine in modern Russia shows a transition from the vision of zero occupation-related harm to the strategy of recognizing, assessing, and managing occupational exposures. The system of workplace monitoring is developing successfully, with the creation of a federal database for the state of working conditions and the implementation of mechanisms for occupational risk assessment and management. However, at the same time, the system of medical surveillance for workers needs substantial reform. Over the past few years, the professional community of specialists in occupational medicine has taken several steps to improve the quality of its work. Understanding of the need for reforming the system of occupational medicine has continued to grow, which will improve the quality of medical monitoring for workers and extend professional longevity. Current challenges and prospects of occupational medicine in the Russian Federation are discussed.
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