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7явлению факторов влияния. Полученные предварительные результаты близки к ожидаемым и по многим параметрам почти совпадают с опубликованными данными зарубежных исследователей. В то же время, национальные особенности накладывают определенный отпечаток на формулировку некоторых параметров, что требует отдельной проверки валидности и результативности всей когорты обследования.
СПИСОК ЛИТЕРАТУРЫ:
1. Васильченко Г.С. Общая сексопатология. Руководство для врачей. М., «Медицина», 1977, 488с.
2. Кащенко Е.А. Основы социокультурной сексологии. Издательские решения, 2011. 363 с.
3. Schmitt, D.P, & Buss, D.M. Sexual dimensions of person description: Beyond or subsumed by the Big Five? Journal of Research in Personality, 34, 2000, 141-177.
4. Regoli R.M., Hewitt J.D., DeLisi M. Delinquency in Society: The Essentials. Jones & Bartlett Learning, 2011. 547 S.
5. Hatfield, E., & Rapson, R. L. Passionate love and sexual desire: Cultural and historical perspectives. In A. L. Vangelisti & H. T. Reis (Eds.), Stability and change in relationships (pp. 306-324). New York: Cambridge University Press, 2002.
6. Caralis, D., & Haslam, N. Relational tendencies associated with broad personality dimensions. Psychology and Psychotherapy: Theory, Research and Practice, 2004, 77, 397-402.
7. Агарков С.Т. Сексуальность от зачатия до смерти: онтогенез сексуальности. Издательские решения, 2015. 491 с.
8. Schmitt, D. P., Realo, A., Voracek, M., & Al-lik, J. (2008). Why can't a man be more like a woman? Sex differences in Big Five personality traits across 55 cultures. Journal of Personality and Social Psychology, 2008, 94, 168-182.
ANALYSIS OF THE PROBLEMS OF PERIODIC MEDICAL EXAMINATIONS OF AGRICULTURAL
WORKERS
Shirokov Yu.,
doctor of technical Sciences, Professor, Russian state agrarianUniversity-Moscow agricultural Academy.
K. A. Timiryazeva, Moscow, Rossiya Ivakina E.,
Candidate of Technical Sciences, Associate Professor,Russian state agrarian University-Moscow agricul-
turalm Academy. K. A. Timiryazeva. Moscow, Rossiya
Tikhnenko V.,
Candidate of Technical Sciences, Associate Professor. Russian state agrarian University-Moscow agricultural Academy. K. A. Timiryazeva. Moscow, Rossiya
Kovrigo O.
Engineer, senior lecturer epartment., Russian state agrarian University-Moscow agricultural Academy. K.
A. Timiryazeva. Moscow, Rossiya
Abstract
The article is devoted to the problems of periodic medical examinations of agricultural workers. The research methodology is based on the analysis of the presence of harmful production factors in the workplace of agricultural workers, the generalization of research materials on the impact of these factors on the health of workers and the analysis of problems that occur during periodic medical examinations. In conclusion, recommendations are made to improve the organization and efficiency of periodic medical examinations of agricultural workers, including: labor protection services of agricultural enterprises to require medical institutions to study in advance and timely identify early signs of occupational pathology, taking into account the actual risk factors in agriculture, to actively implement telemedicine technologies that can "bring" a highly qualified doctor to rural workers, go to remote medical monitoring of the health status of employees, receive timely primary information about changes in health status and conduct periodic medical examinations based on the primary data on changes in the health status of employees, then deepen the target studies to make a decision about the diagnosis, prevention measures, etc. This will ensure timely preventive treatment and organize rational employment of employees with signs of the initial stage of occupational diseases.
Keywords: occupational diseases; agriculture; harmful production factors; effectiveness of periodic medical examinations; assessment of work-related relationships.
Introduction.
An important task in the context of the current trend in Russia to reduce the working-age part of the population and relatively low labor productivity is to take care of the health of employees and preserve them in the production process. This can be achieved by timely detecting the first signs of occupational diseases
and taking immediate effective preventive measures to prevent their development and restore partially lost health.
According to the Ministry of Labor, as of December 26, 2019, a special assessment of working conditions was carried out at 764.5 thousand employers for 32.5 million jobs. The number of employees employed
in these jobs is 43 million. The proportion of workers employed in harmful or dangerous working conditions is about 21%.
The number of detected occupational diseases due to exposure to harmful industrial factors has decreased. In 2017, 5.8 thousand cases of occupational diseases were detected, in 2018 — 5.1 thousand cases of occupational diseases per 43 million employees, the indicator of occupational morbidity decreased from 1.47 per 10 thousand employees in 2016 to 1.31 in 2017 and to 1.17 in 2018. (data from the Federal Service for Supervision of Consumer Rights Protection and Human Welfare). But whether the level of occupational diseases has decreased or only the level of their registration (identification).
However, at the same time, in countries with incomparably better working conditions, the same indicator is: in Belgium-18 people who received occupational diseases per 10 thousand employees, in Ger-many-22, Israel-23, Italy-37, Norway -45, Finland and France -79, etc. On average in the EU-35 cases per 10 thousand employees [1].
In most sectors of the economy, sanitary and hygienic working conditions are still no better than in these countries. Over the years, little has changed in the technological processes and equipment of production. This means that, if we use the method of analogues, then in reality, occupational diseases in Russia can be acquired annually by at least 150 thousand people. But this is not diagnosed during periodic medical examinations. Or pathologies are not associated with working conditions. Or inspections are carried out formally (not carried out).
The probable reason is the low level of organization of preparation for periodic medical examinations by employers and labor protection services of the enterprise and the conduct of periodic medical examinations by medical institutions. This problem is especially relevant for agricultural workers. More than 1.6 million people work in this most important industry, not only in terms of food security, but also in terms of contribution to the foreign trade balance. A significant proportion of them (according to Rosstat — more than 33%)
are engaged in work with harmful and (or) dangerous working conditions (see Fig.). The health of agricultural workers is negatively affected by heavy physical labor and unfavorable microclimatic conditions, various harmful production factors of the chemical and biological nature of the impact, in a number of technological operations — directly poisons [2]. The urgency of the problem increases due to the ongoing increase in the retirement age and the share of age-related workers in the production process, who will be affected by harmful production factors for another five years [3].
The purpose of the study is to develop proposals for improving the quality and efficiency of periodic medical examinations of agricultural workers.
The research methodology is based on the analysis of the presence of harmful production factors in the workplaces of agricultural workers, the generalization of research materials on the impact of these factors on the health of workers and the analysis of problems that occur during periodic medical examinations.
Results and discussion. The peculiarity of agriculture is that medical care for workers, including high-quality preliminary and periodic medical examinations, is the most complex and much less accessible than in other urbanized sectors of the economy.
The second feature: weak organizational and managerial work at agricultural enterprises on the formation of an effective labor protection management system. This is due to the shortage of highly qualified personnel: the position of a specialist in labor protection (head of the labor protection service) is occupied by people of various specializations and levels of training: a little more than 12% work with higher education. Every fifth person who holds the position of an occupational safety engineer has a liberal arts education. Without special education, 6% of practitioners work in this position [2].
And the third feature of agriculture: almost all enterprises are designed to ensure high profitability and create optimal conditions for biological objects: animals, birds, plants, fungi, etc., but do not take into account the provision of acceptable conditions for service personnel who have been forced to perform labor functions in unfavorable conditions for decades (Table 1).
Table 1
Animal groups Indoor air temperature, ° C Relative humidity in the room, %
max min max min
Boars 19 13 75 40
Single and pregnant sows 19 13 75 40
Fattening pigs 20 14 70 40
Normative values of temperature and humidity of indoor air in premises for keeping pigs of different sex
and age groups
(Departmental norms of technological design of pig-breeding enterprises VNTP 2-96, Ministry of Agriculture
and Food of the Russian Federation, Moscow, 1996)
A comparison of the sanitary and hygienic requirements for the permissible levels of air temperature and humidity for the employee and the same parameters in the buildings of livestock farms and complexes, poultry farms, shows that they differ markedly. Even the max-
imum temperature recommended for the design of livestock farms and complexes is 2-5 ° C lower than the permissible temperature for the operator, and 4-9 ° C lower than the minimum temperature. There is an even greater difference in the values of the air velocity: here the difference is 2-3 times (Table 2).
Table 2
Normative values of air velocity in livestock premises
(Departmental norms of technological design of pig-breeding enterprises VNTP 2-96, Ministry of Agriculture _and Food of the Russian Federation, M., 1996.)_
Name of premises Indoor air velocity, m / s
calculated in the cold and transitional periods of the year permissible in the warm season
Pig quarters
Rooms for single and gestating queens and boars 0,3 1
Premises for the repair of young animals and weaned piglets 0,2 0,6
Premises for fattening young animals 0,3 1
Premises for farrowing and keeping suckling queens with suckling pig 0,15 0,4
We conducted research on the state of working conditions at the workplaces of operators at the pig complex of CJSC BIO-M of the Bryansk region. It is established that the parameters of the microclimate in the livestock premises of the enterprise do not meet the sanitary and hygienic standards. The relative humidity in the premises exceeds the standard for humans (75-90 %), the temperature does not reach the standard values: 8-18 °C. This creates conditions for the occurrence of both colds and occupational diseases. The data are also consistent with the results of other researchers (Fedo-tova E. V., 1996,. Lukina M. V., 2010).
The noise level during the distribution of feed, processing of premises and animals (for example, during vaccinations) reaches 86-96 dB. The maximum sound pressure is at high frequencies up to 8000 Hz.
The content of ammonia in the morning hours is more than 20 mg / m3, hydrogen sulfide-10 mg/m3, which exceeds the permissible concentrations (MPC) of harmful substances in the air of the working area (approved by GN 2.2.5.3532-18). Resolution of the Chief State Sanitary Doctor of the Russian Federation No. 25 of February 13, 2018.
The situation is similar in other branches of animal husbandry: along with the unfavorable microclimate, workers (especially in dairy complexes with non-walking cattle) are affected by the presence of high concentrations of a number of toxic substances in the air environment of industrial premises. The content of ammonia exceeds the MPC by 2.25-7.5 times, the content of hydrogen sulfide — by 2.5-5 times, bacterial contamination — by 8.6-13.6 times [3].
According to the FAO, 9% of carbon dioxide, 37% of methane, 70% of ammonia entering the Earth's atmosphere are produced in animal husbandry. But before entering the atmosphere, these gases are contained in the air of the working area and affect the organisms of employees of livestock farms and complexes.
Along with this, the air of the working area is filled with organic dust formed during the distribution of feed and the introduction of litter, which contains feed protein and vitamin supplements, not infrequently medicines, particles of epithelium and animal hair, fungal waste products, etc.
As a result of a special assessment of the workplaces of pig complex operators, it was found that, according to a number of indicators, working conditions
belong to classes 3.1 and 3.2. The calculation of the severity of the labor process, both livestock breeders and machine milking operators, indicates a high level of influence of this factor and refers the working conditions of workers also to class 3.2, which ultimately gives a general assessment of working conditions-class 3.2.
Long-term research of medical institutions has accumulated a sufficient level of knowledge about the relationship of specific health disorders with harmful factors in the workplace, including agricultural workers [4-6]. Thus, ammonia (hazard class 4), even in low concentrations, leads to the development of pathology on the part of various human organs. Even if the air of the working area contains ammonia close to the MPC (In the air of the working area of industrial premises, the MPC of ammonia is 20 mg/m3-GN 2.2.5.3532-18), this leads to a decrease in the bioelectric activity of the brain, anosmia, a decrease in the level of ascorbic acid in the blood, and a slowdown in the excretion of urea. There are violations of the functions of higher nervous activity, hypotonic reactions, tachycardia, even if the content of ammonia in the air of the working area is within 10 mg/m3 (Grebtsov O. V., 2005; Doblo A. A., 2008; Ryabinina T. V., 2005).
Significant risk to workers ' health of livestock and poultry production are other gases present in the air of working zone — hydrogen sulfide, carbon dioxide, mercaptans (Rowers O. V.,2005. Doblo A. A., 2008).
It is therefore natural that many workers develop respiratory 17.8 per cent, of the gastrointestinal tract and 14.7%, nervous system and sensory organs - 8,2%, musculoskeletal system - 5.8%, urinary tract and 5.5% [4-6].
Along with this, harmful production factors of biological nature, such as brucellosis, foot-and-mouth disease and other zoonotic diseases, also pose a significant threat to the health of livestock workers.
Employees of protected ground enterprises (greenhouses) are in prolonged contact with toxic chemicals against the background of high humidity and temperature (heating microclimate) and high physical activity. Work on the second day after the application of fungicides and insecticides can cause intense damage to the exposed areas of the working body (hands, shins, neck, mucous membranes of the eyes and other organs) [8].
Normally used personal protective equipment does not ensure the safety of employees. As it turned
out, toxic chemicals quickly penetrate into the inner side of the protective equipment. As a result, diseases of the circulatory, respiratory, urinary and digestive systems are most common in greenhouse workers (Ryabinina T. V., 2005).
Due to the influence of toxic chemicals, a serious increase in the frequency of chromosomal aberrations in the peripheral blood lymphocytes of workers of protected soil was revealed (Zoryeva T. D., 1988). The effect of a chemical agent on the body may not be apparent for a long time. Only after years, a person develops chronic inflammatory diseases of the liver, kidneys, pancreas, endocrinopathy, oncological pathology, etc.
The situation with the working conditions of tractor drivers working in the field is no better. Previous studies have shown that tractor drivers under the age of 45 years in 55% of cases, and in 50 years - in 80% of cases suffer from chronic diseases. 17.6% of tractor drivers were diagnosed with "vibration disease", 15.5% - "sensorineural hearing loss". In tractor drivers and combine harvesters, degenerative-dystrophic changes in the spine are often diagnosed due to continuous vertical low-frequency vibrations of a jolting nature when the machine-tractor unit moves along the irregularities of the field [9-11].
Due to health problems, up to 70 % of experienced and highly qualified machine operators are forced to leave the work of a tractor driver for 10-12 years before the retirement age. At the same time, the loss of their health is not legally linked to working conditions, which leads not only to the lack of compensation, but also to the complete loss of sources of income.
When machine operators switch to modern, more comfortable and computerized equipment, new types of risks arise due to the combination of the traditional tension of the tractor driver with the tension of the dispatcher and the PC operator. The workplace of a modern tractor, as a rule, is equipped with several video terminals, which are designed to facilitate the management of technological operations, the engine and transmission of the machine and tractor unit. Often, this is added to the control of an unmanned aerial vehicle that accompanies field operations and transmits signals to control, for example, the valves of the fertilizer spreader, thus adjusting the dose of their application depending on the state of the crops. This is designed to facilitate the work of the machine operator. But at the same time, the working conditions behind the video terminal are the opposite of those that are familiar to the eyes of a tractor driver.
In a traditional tractor, the tractor driver perceives mainly reflected light, and the objects of observation are continuously in the field of view for at least a few seconds. When working at the video terminal, the tractor driver has to deal with self-luminous objects and a discrete (flickering with a high frequency) image, which increases the load on the eyes. To this is added the sharp contrast between the background and the symbols, the unusual shape of the symbols, different than when reading a book, the direction of view, glare and reflections on the screen, changing with each turn of the tractor. Intense visual work causes headaches, increased neuropsychiatric tension. This increases fatigue, reduces performance [9,12]. Thus, new challenges are emerging, with the chronic impact of which
new types of occupational diseases can also arise. And these harmful factors must be taken into account during periodic medical examinations of tractor drivers.\
Among a number of reasons for not detecting occupational diseases are the low level of organization and conduct of periodic medical examinations of agricultural workers and the lack of training of medical workers for causation (assessment of the connection of the disease with work) [13-15]. This is confirmed by the deputy.the head of Rospotrebnadzor I. V. Bragina: "The reasons for this level of registration of occupational morbidity are the low detection of diseases during periodic medical examinations, the concealment of existing risks of developing occupational diseases, the termination of labor relations at the initial signs of diseases."
Surveys conducted among specialists involved in conducting medical examinations of employees have shown that the doctor involved in conducting periodic medical examinations is not focused on identifying early signs of occupational diseases and does not have sufficient information about the spread of occupational diseases in specific industrial conditions [15-17].
Doctors note the biased indicators of occupational morbidity, the main reasons for which are called incomplete coverage of periodic medical examinations of employees (58%), unsatisfactory quality of periodic medical examinations (86%), concealment of complaints by employees and late access to medical care (16%) [15,16]. This is probably the reason for achieving a low level of occupational morbidity (1.17 per 10 thousand employees).
A number of authoritative authors propose a fundamentally new approach to predicting the probability of occupational diseases, as well as quantifying the degree of connection with working conditions in the workplace with computer support programs from the electronic handbook "Occupational Risk" [18]. A fair conclusion is made about the need for legal recognition of diseases associated with working conditions in the workplace, for early diagnosis and prevention of health disorders of employees in the conditions of digitaliza-tion of the economy and society.
Conclusion
In our opinion, it is necessary to supplement these proposals with the following measures in relation to the specifics of medical examinations of agricultural workers:
- eliminate the formal approach to conducting periodic medical examinations, for which the medical staff should be prepared in advance to study the presence and actual levels of harmful production factors at the workplace of each employee who came to the examination. To do this, the labor protection services of agricultural enterprises are required to submit in advance to the members of the commission the results of a special assessment of specific workplaces on the working conditions of employees sent for surveys. Members of the medical commission, in accordance with their specialization, should be ready to compare the actual state of health of employees with the typical consequences of prolonged exposure to harmful industrial factors in relation to a particular workplace. Any doubts should either be interpreted in favor of the employee, or lead to the need to deepen research on the relationship of the disease with working conditions;
- more actively implement telemedicine technologies, artificial intelligence, at first at least the simplest, such as the Telemedic system, which can "bring" a highly qualified doctor to rural workers. It is advisable to switch to remote medical monitoring of the health status of employees who are constantly in the zone of harmful industrial factors, to receive timely primary information about changes in their health status and conduct periodic medical examinations already on the basis of these preliminary data, deepening targeted research to make a decision about the diagnosis and prevention methods;
- analyze the results of the annual periodic medical examinations of employees of agricultural enterprises and clarify the presence of a causal relationship between the state of health and harmful production factors present at this workplace. Have constant contact with the management of the occupational health and safety services of enterprises in order to develop effective measures in a timely manner to reduce the level of exposure to harmful production factors by technical, technological or organizational methods. In the absence of such opportunities-to ensure the timely and rational employment of employees with signs of the initial stage of occupational diseases and the implementation of mandatory preventive measures to restore the health of employees.
In addition to the above, it is advisable, first, to introduce, as is the case in some countries, the presumption of loss of health in the proven presence and time of presence in the workplace of harmful production factors that exceed sanitary and hygienic standards.
Secondly, to give the employee the right to prove a causal relationship between the state of health and the presence of harmful production factors in the workplace in cases where the detected disease is not included in the list of occupational diseases, so that the disease is recognized as a professional one with appropriate material compensation for the employee.
REFERENCES:
1. The European portal of health information. WHO; 2019. https://gateway.euro.who.int/ru/. (in Russian)
2. Shirokov Ju.A., Smirnov G.N. Actual problems of labor protection in modern agriculture.. In: Applied, search and fundamental socio-economic research: integration of science and practice. Samara; 2018: 57-72. (in Russian)
3. Shirokov Ju.A. Assessment of risks in the sphere of occupational safety in connection with the increase in the retirement age. Bezopasnost' truda v promyshlennosti. 2020; 6: 29-34. (in Russian)
4. Morbidity of livestock workers. https: //prom-nadzor.ru/content/zabolevaemost-rabotnikov-zhivotnovodstva. (in Russian)
5. Izmerov N.F. red. Occupational disease. Guide for doctors. M.: Medicina; 1996. (in Russian)
6. Lukina M. V. Occupational diseases of agricultural workers. Information letter. Kurgan; 2010. http:// uniim.rospotrebnadzor.ru. (in Russian)
7. Gurina I.V. Safe level of carbon dioxide requires revision.. Jekologicheskij vestnik Rossii. 2008;
9; http://enontek.ru/publikacii/ehkovestnik-9-2008. (in Russian)
8. The content of working conditions and occupational health risks of greenhouse workers: information and methodological letter. Ufa; 2016. https://uniim.rospotrebnadzor.ru. (in Russian)
9. Novikova T.A., Danilov A.N., Spirin V.F. Influence of economic factors on formation of professional risk of deterioration of health of machine operators of agriculture. Medicina truda i promyshlennaja jekologija. 2019;1(7); 400-405. URL: https://doi.org/10.31089/1026-9428-2019-59-7-400-405. (in Russian)
10. Shirokov Ju.A. Risk Factors of tractor drivers in agricultural production. Materialy mezhdunarodnoj nauchnoj konferencii. 2018: 263-266. (in Russian)
11. Novikova T.A., Spirin V.F. Hygienic classification of working conditions and occupational health risk assessment of tractor-drivers of agricultural production. Zdorov'e i okruzhajushhaja sreda. 2015; 2 (25): 37-40. (in Russian)
12. Shirokov Ju.A. Analysis of expected problems with labor protection of machine operators in the transition to modern technology. Sb. statej po itogam II mezhdunarodnoj nauchno-prakticheskoj konferencii "GORJaChKINSKIE ChTENIJa", posvjashhennoj 150-letiju so dnja rozhdenija akademika V.P. Gorjach-kina. M.: 2019: 166-170. (in Russian)
13. Watanabe K., Tabuchi T., Kawakami N. Improvement of the work environment and work-related stress: a cross-sectional multilevel study of a nationally representative sample of japanese workers. J Occup and Environ Medicine. 2017; 59(3): 295-303. DOI: 10.1097/JOM.0000000000000950.
14. Hu N.Ch., Chen J.D., Cheng TJ. The associations between long working hours, physical inactivity, and burnout. J Occup and Environ Medicine. 2016; 58(5): 514-8. 10.1097/JOM. 0000000000000715. DOI: 10.1097/JOM.0000000000000715.
15. Gudinova Zh.V., Blinova E.G., Gegechkori I.V., Zhernakova G.N., Tol'kova E.I. Influence of socio-economic conditions and health on the quality of work of specialists taking part in medical examinations of workers. Sovremennye problemy nauki i obrazovanija. 2013; 6. http://science-education.ru/ru/article/view?id=11075. (in Russian)
16. Staseva E. V., Tepljakova N. A. Medical examination as a factor of early diagnosis of occupational diseases. Molodoj uchenyj. 2016;18;1: 21-23 https ://moluch. ru/archive/122/33779/.(in Russian)
17. Troshin V.V., Umnjagina I.A., Orlov A.L. Risk factors of working capacity of workers and the use of the index of working capacity for EEG. Medicina truda i promyshlennaja jekologija. 2019;1(10):882-886. https://doi.org/10.31089/1026-9428-2019-59-10-882-886. (in Russian)
18. Buhtijarov I.V., Denisov Je.I., Lagutina G.N., Pfaf V.F., Chesalin P.V., Stepanjan I.V. Criteria and algorithms for establishing the connection between health and work. Medicina truda i promyshlennaja jekologija. 2018;(8):4-12. https://doi.org/10.31089/1026-9428-2018-8-4-12. (in Russian)
