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UDC 613.62:656.211.5
MEDICAL AND HYGIENIC ASPECTS OF DERMATOLOGICAL MORBIDITY IN EMPLOYEES OF JSC "RUSSIAN RAILWAYS"
Altai State Medical University, Barnaul
Institute of Occupational Health and Industrial Ecology of ASMU, Barnaul O.A. Karpova12, B.A. Balandovich12, A.S. Nagornyak1
The article presents a comparative statistical analysis of the dermatological morbidity of railway transport workers, as well as of the population attached to non-governmental health care institutions of JSC Russian Railways (JSC RZhD) and the territorial population of the Russian Federation. In the course of the research, the combined and additive effect of unfavorable factors of the working environment and the labor process on the organism of employees of JSC RZhD was established. The main of them are the intensity of the work process, noise, vibration, unfavorable microclimate. The work proves that the impact of unfavorable production factors on the employees of JSC RZhD led to a 1.2-fold increase in the overall incidence of skin and subcutaneous tissue disorder in comparison with the territorial population of the Russian Federation, and is 1.4 times higher than in the population attached to the NHI "JSC RZhD".
Key words: unfavorable production factors, special assessment of working conditions, workplace, general dermatological morbidity, primary dermatological morbidity, railway transport workers.
According to the results of social and hygienic monitoring, 60.9% (89.08 million people) of the Russian population are exposed to combined effects of environmental factors of various nature. In the structure of the working population of the country, approximately 17.5 million people are affected by adverse production factors. In turn, in a cohort of workers exposed to occupational risks, workers of transport and communications stably hold the third position (13.05%), second only to workers in the manufacturing and extractive industries.
According to the Strategic Development Program of JSC "Russian Railways" until 2030, one of the company's priorities is to ensure safe working conditions, reduce occupational injuries and occupational diseases through the use of maximally safe technological processes and equipment. Another strategy to improve the health of employees of JSC "Russian Railways" for the period until 2020 displays a clear system of measures to preserve the professional longevity of the company's employees, which has developed in railway medicine [4, 5].
Despite the more than 150-year history of the development of the sectoral transport healthcare, scientific studies have not been conducted so far in which the impact of working conditions on the prevalence of skin and subcutaneous tissue disorders in railway transport workers would be systematically and comprehensively studied. This indicated the relevance of this study and determined its purpose.
The purpose of the study is to conduct a comparative analysis of the general and primary incidence in the class of "Diseases of the skin and subcutaneous tissue" in the population attached to the NHI "JSC RZhD", railway transport workers and the territorial population of the Russian Federation.
Materials and methods
For statistical analysis, the following data were used: data from the Rosstat database URL: www. gks.ru, the Department for Monitoring, Analysis and Strategic Development of Health of the Ministry of Health of the Russian Federation, Federal State Institution "Central Research Institute of Health Organization and Informatization" of the Ministry of Health of the Russian Federation http://old.rosminzdrav.ru, statistical reports of the Central Directorate of Health, a branch of JSC RZhD [1, 3, 6, 7, 8, 9].
The statistical processing of the results was carried out using the "Statistica 10.0" software package. Normality of the distribution of quantitative traits in sample populations was determined using the Shapiro-Wilk W-test. The descriptive statistics were given in the text in the form of mean and standard deviation (M ± SD). For comparison of groups with the distribution of a characteristic other than normal, nonparametric methods were used: the Mann-Whitney U test. Differences were considered statistically significant by p <0.05.
Results and discussion
The "Russian Railways" employs a total of 864,000 employees, they occupy 425,000 positions. According to the results of a special assessment of working conditions, 462,000 employees of the company work at 158,600 workplaces in harmful labor conditions at JSC RZhD. The maximum specific weight in the structure of workplaces with the impact of harmful production factors on the "Russian Railways" is the intensity of the labor process - 61,500 jobs. In such conditions, workers of the majority of railway specialties work: engineers, assistant locomotive and electric locomotive drivers, ZHSM, ITR, ticket cashiers, accountants,
maintenance point operators, station technology centre operators, shunting dispatchers, park attendants. Production noise affects locomotive drivers and their assistants, conductors of passenger cars, tractor drivers, track monitors, compressor engine operators, autoclave operators, electropliers, thermists, smiths, locksmiths, tinsmiths, turners, carpenters, , which amounted to 58,000 workplaces at JSC RZhD. For 57,300 jobs, including professional groups of path installers, foremen of the road, signalers, the priority harmful production factor is the burden of labor. An unfavorable microclimate is noted on the rolling stock, in the station-shunting group of workers of the way, among the workers of the energy supply (electrification) group and constitutes 78.0% of the total number of jobs. The excess of hygienic standards for general vibration is noted for 24,200 jobs in a group of drivers and workers in professional groups serving trains en route. Exceeding remote control for local vibration is noted for 7,900 workplaces, where the machinists, assistants of diesel locomotive drivers, electric locomotives, electric trains, railway cars, railway cars, tractor drivers, track mechanics, blacksmiths, tinsmiths work. Exceeding the maximum allowable concentration of chemical substances of various hazard classes in the air of the work area is noted for 14,000 jobs of drivers, car mechanics, oil spill cleaners, locomotive crews, track monitors, conductors of passenger cars, duty officers, laboratory assistants, electric and gas welders, dry cleaners, battery-holders, painters, rubber molders, washing cleaners of rolling stock, cleaners of industrial premises [4].
The distribution of jobs at JSC RZhD according to the classes of working conditions is characterized by the following structure: class 3.1 - 17.9%, class 3.2 - 15%, class 3.3 - 3.9%, class 3.4 - 0.4% [4].
The activities of structural divisions of JSC RZhD have a pronounced specificity in ensuring the safety of train traffic in conditions of shortage of time and high responsibility for the result of work. Work
on rail transport has a traveling character in several climatic zones and belts, with insufficient duration and unsatisfactory quality of rest, inability to comply with physiologically necessary sleep and nutrition. Influence of physical, chemical factors of the production process, unstable microclimate, psychoemotional stress, monotony of labor, lack of exercise, long stay in forced position in many workers of the branch are noted [2].
Professional skin diseases remain an important problem of railway medicine, since dermatology is one of the least developed areas of sectoral health care. Professional dermatoses significantly worsen the quality of life of patients, since they often disfigure their appearance, lead to social and psychological disadaptation, cause feelings of anxiety, depression and, as a result, can affect the safety of train traffic.
The state of working conditions has a significant impact on the health of railway workers. Dermato-logical morbidity in some cases is related to professional activity. The most common skin diseases are among workers in contact with occupational hazards.
In accordance with the order of the Ministry of Health of the Russian Federation No. 796 "On approving the list of medical contraindications to work directly related to train movement and shunting work", the presence of common, often exacerbated diseases associated with open areas of the skin is a medical contraindication for both those entering the workplace and old employees, ensuring the safety of train traffic.
Up to 53.5% of specialties on the "Russian Railways" are exposed to harmful and dangerous working conditions by factors of the working environment [2]. This led to a greater prevalence of skin and subcutaneous tissue disorders among the company's employees compared to the population attached to the NHI JSC RZhD and the territorial population, as shown in Table 1.
Table 1
Total incidence of the class "Diseases of the skin and subcutaneous tissue" (per 1000 adults) in 2010-2015.
Population/year 2010 2011 2012 2013 2014 2015
1 RZhD (per 1000 people) 61,4 61,5 59,1 61,3 57,3
NHI (abs.) 141342 131744 130232 133915 121237 113360
2 NHI (per 1000 people) 44,6 42,1 42,4 45,0 41,9 40,3
3 RF (per 1000 people) 50,9 50,7 51,1 50,9 51,0 49,7
Note: significance of differences: p (1-2)=0,007937; p (1-3)=0,000041; p(2-3)=0,004329
In 2015, 827.4 thousand employees of the company provided medical assistance in non-governmental health care facilities of NHI JSC RZhD, which amounted to 29.2% of the total assigned population (in 2014, 30.0%).
In 2015, 113 360 cases of skin and subcutaneous tissue disorders were registered in non-governmental health facilities of JSC RZhD (2014: 121237, 2013: 133,915).
For the period from 2010 to 2015, the overall incidence rate for the class of "Diseases of the skin and subcutaneous tissue" among the population attached to the NHI JSC RZhD averaged 42.7 ± 1.8 per 1000 adult population. The largest indicator, 45.0 per 1,000 adults, was registered in 2013. By the end of the period, the incidence decreased by 10.4%, reaching the lowest level of 40.3 per 1,000 adult population (Table 1).
The share of diseases of the skin and subcutaneous tissue in the structure of the general morbidity of the adult population fluctuated insignificantly 3.7% ± 0.21 and corresponded to the 11th ranked place for six years.
When comparing the prevalence indicators, the population attached to NHI JSC RZhD and the adult population of the Russian Federation showed a significantly higher prevalence of dermatoses among the territorial population (p = 0.004329).
In 2015, in 48,706 employees of Russian Railways there were identified various skin and subcutaneous tissue disorders (2014 - 55,661 people, 2013 - 48,706 people). Employees of the company
In 2015, in NHI JSC RZhD there were 71,980 skin and subcutaneous tissue diseases registered for the first time (2014 - 76,991 people, 2013 - 83,441 people).
Analysis of primary incidence in the class of "Diseases of the skin and subcutaneous tissue" for 2012-2015 shows that a persistent downward trend is observed in all groups analyzed. Over a four-year period, dermatological morbidity among employees of JSC RZhD decreased by 13.5%, in the attached population - by 11.7%. Slowest incidence was regressed in the adult territorial population of the Russian Federation - 6.8%.
According to the results of the analysis of der-matological morbidity in the studied population groups, it was revealed that the highest rates were observed among the population of the Russian Federation as a whole (2012: 38.5, 2015: 35.9 per 1,000 adults), slightly lower - in JSC RZhD workers (2012: 37.8, 2015: 32.7 per 1,000 employees), and the smallest - among the population attached to NHI (2013: 28.0, 2015: 25.6 per 1000 adults) (Table 2).
For the period from 2012 to 2015, for the first time in life, the identified skin and subcutaneous tissue disorders among the population attached
in the structure of the overall dermatological morbidity of NHI amounted to 43.0% (2014 - 45.9%, 2013 - 36.4%).
By 2015, the prevalence of skin and subcutaneous tissue disorders among railway workers fell by 6.8% to 57.3 per 1,000 workers, compared to the largest five-year indicator - 61.5 per 1,000 employees (2012). The total dermatological morbidity for the analyzed period per 100 employees of JSC RZhD corresponded to the level of 60.1 ± 1.9.
A comparative analysis of the overall morbidity in the class of "Diseases of the skin and subcutaneous tissue" in the employees of JSC RZhD showed that with high reliability (p = 0.007937) it is 1.4 times higher than those of the attached to NHI and 1.2 times (p = 0.000041) higher than in the adult territorial population of the Russian Federation. The systematic preventive work of JSC RZhD "Health" led to the fact that the total dermatological morbidity in the population attached to NHI is 1.4 times lower than that of the employees of JSC RZhD, and 1.2 times lower than in the adult population of the Russian Federation.
to the Russian Railways JSC were on average 27.3 ± 1.5 per 1,000 adults.
The primary dermatological morbidity from 2012 to 2015 for 100 employees in JSCo «Russian Railways» corresponded to the level of 36.2 ± 2.4 per 1000 employees.
From 2012 to 2015, the newly diagnosed dermatoses among the territorial population of the Russian Federation averaged 37.4 ± 1.1 per 1,000 adults.
When comparing the incidence indicators, the population attached to NHI JSC RZhD and the adult population of the Russian Federation showed a significantly higher prevalence of dermatoses among the territorial population (p = 0.000041).
Primary dermatological morbidity per 1000 employees at JSC RZhD with a high degree of reliability (p = 0.028571) is higher than these indicators in the adult population attached to NHI.
There were no statistically significant differences in the primary incidence of skin and subcutaneous tissue diseases between employees of Russian Railways and the territorial population of the Russian Federation during the analysis (p = 0.485714).
Such differences in morbidity in the study groups can be explained by the high level of pre-
Table 2
Primary incidence of the class "Diseases of the skin and subcutaneous tissue" (per 1000 adults) in 2012-2015.
Population/year 2012 r. 2013 r. 2014 r. 2015 r.
1 JSC RZhD employees (per 1000 people) 37,8 37,8 36,3 32,7
2 Attached (per 1000 people) 29,0 28,0 26,6 25,6
3 RF (per 1000 people) 38,5 37,9 37,4 35,9
Note: significance of differences: p (1-2)= 0,028571; p (1-3) = 0,485714; p (2-3 ; )= 0,000041
ventive work systematically conducted in NHI, the improvement of the transportation process and the improvement of working conditions at the enterprises of JSC RZhD. This assumption is confirmed by the fact that the share of the primary disease in the general structure of dermatologi-cal diseases among workers of JSC RZhD was 60,5% ± 3,0, the population attached to NHI JSC RZhD -63,3% ± 3,8, in adult population of Russia - 74, 3% ± 1.5. The largest component of the primary disease in the total structure is noted among the workers of JSC RZhD, is lower in the population attached to NHI, and is the lowest among the territorial population, indicating that the effect of length of service in hazardous working conditions on the incidence of dermatoses, which is growing faster on this indicator than increase in age.
Conclusions
1. Work on rail transport is associated with a long-term and intensive force of physical, chemical factors of the production process, unstable microclimate, psychoemotional stress, monotony of labor, hypodynamia, long-term presence in a forced position in 53.5% of the workers in the industry.
2. The impact of production factors on the employees of JSC RZhD reflected in the greater incidence of diseases of the skin and subcutaneous tissue than in the territorial population of the Russian Federation by 1.2 times.
3. Preventive work carried out by JSC RZhD led to the fact that the indicators of the general incidence of diseases of the skin and subcutaneous tissue among the population attached to NHI are 1.2 times lower than the territorial figures.
4. The primary incidence of diseases of the skin and subcutaneous tissue among employees of JSC RZhD is slightly lower than that of the territorial population of the Russian Federation.
5. The work carried out by Russian Railways to protect and prevent health, improve working conditions and the quality of medical care has resulted in a significantly lower primary dermato-logical morbidity among the population attached to NHI RZhD than that of its employees and residents of the Russian Federation as a whole.
6. Evaluation of the intensity and duration of the impact of factors of the labor process on workers and the development of medical prevention of occupational risks makes it possible to preserve the professional longevity of railway workers.
References
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Contacts
Corresponding author: Karpova Olga Anatolievna, Candidate of Medical Sciences, Senior researcher of the Institute of Occupational Health and Industrial Ecology of ASMU, dermatovenereologist of NHI "Multiprofile hospital of JSC Russian Railways at the Barnaul station", chief external expert on dermatovenereology of the West Siberian Directorate of Health of JSC RZhD, Barnaul. 656038, Barnaul, Lenina Prospekt, 40. Tel.: (3852) 566869. E-mail: o.a.karpova@yandex.ru
Balandovich Boris Anatolievich - Doctor of Medical Sciences, Associate Professor, Head of the Institute of Occupational Health and Industrial Ecology of the Altai State Medical University, Barnaul. 656038, Barnaul, Lenina Prospekt, 40. Tel.: (3852) 566898. E-mail: dr.balandovich@mail.ru
Nagornyak Alexey Sergeyevich, postgraduate student of the Department of Hygiene, Basics of Ecology and Life Safety of the Altai State Medical University, Barnaul.
656038, Barnaul, per. Nekrasova, 65.
Tel.: (3852) 566898.
E-mail: tezaurismosis@gmail.ru
