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7J.A. Rizaev, Y.Sh.Ruzimurotova, G.A. Khaydarova
THE IMPACT OF SOCIAL AND HEALTH FACTORS AT WORK AND AT HOME ON NURSES' HEALTH
The problem of preserving the health of the working population is the basis of the social policy of the state. The Constitution of the Republic of Uzbekistan and the labour legislation stipulate the rights of employees to safe working conditions, to receive information about the existing risk of health damage and the obligation of the employer to ensure the safety of workers and inform them about the existing risk of health damage in the workplace, as well as to carry out measures to preserve and improve the health of workers.
Key words: health workers, social and hygienic factors.
Introduction: The work of health care workers belongs to the important, complex and responsible human activities associated with a high intellectual and nervous-emotional load. The result of medical workers' activity -public health - is largely determined by working conditions and the state of their health.
The problem of preserving the health of the working population forms the basis of the State's social policy. The Constitution of Uzbekistan and labour legislation stipulate that employees have the right to safe working conditions, to receive information about the existing risk of health damage, and that employers are obliged to ensure the safety of employees and inform them about the existing risk of health damage in the workplace, as well as to implement measures to preserve and promote the health of workers. The above fully applies to health care workers.
In the course of their work, health care workers may be exposed to occupational hazards, i.e. various unfavourable factors of the working environment and work process. Nowadays, there are a significant number of specialties of health care workers, which have their own peculiarities in terms of working conditions and work performed.
Among the main factors of occupational hazards in healthcare workers there are practically all hazards characteristic of the majority of unfavourable industries. The mortality rate of medical workers under 50 years of age is 32% higher than the national average. Occupational diseases are registered, as a rule, in the following professional groups: nurses - 43.5%, doctors - 24.5%, nurses - 10%, laboratory assistants - 2.5%.
Physical factors accompanying the work of medical workers It is established that in each group of specialists the leading value belongs to a certain factor or their combination. Sources of electromagnetic radiation. The widest application in medical practice of electromagnetic fields (EMF), describing both the properties of a substance and its direct influence on it, with the purpose of changing the properties of the latter, is logical. In the first case it is diagnostics, in the second - therapy. The physical laws of electromagnetism underlie x-ray (analogue, digital), radionuclide diagnostics, single photon emission computed tomography, positron emission tomography (PET), NMR, electroencephalography (EEG), rheography, myography, electrocardiography (ECG), laser diagnosis and others, which are widely used in diagnosis.
Electromagnetic radiations (EMR) are represented by methods and means, using in their arsenal, the entire spectrum of field frequencies: from hyper-high - gamma-radiation with a frequency of 3*1019 Hz, to low-frequency, with a frequency of 3-30 Hz. The current understanding of the mechanism of the biological effects of EMR is the transfer of energy, which is a force acting on a charge, or rather on a charged particle. Describing biological effects that occur in response to the interaction of each frequency band EMR, it can be noted that the most fully and scientifically studied dose-dependent effects caused by ionizing radiation. As for the EMR of the high-frequency spectrum band, its biological effects in clinical practice today are characterized as "thermal" for microwave, "reflexogenic" for EHF. The penetrating power of radiation in inductothermy is 6-8 cm followed by heat formation. EMP of ultra-low frequency in clinic is used in the form of constant, alternating, pulsed, running, rotating magnetic fields, differing in intensity, direction of speed of movement in space. Magnetic inductions of 2 to 50 mTl and frequencies of 50 to 100 Hz are the most widely used. Penetration into tissues depends on the design of the apparatus. Dosimetry based on them has empirical observations and is based on values of magnetic induction of the emitter and irradiation time, which are chosen arbitrarily, based on heterogeneous results of empirical observations. Radiofrequency range (RF) EMR is used in physiotherapy, surgery and oncology. In physiotherapy rooms, EMFs of different frequencies, intensities and modulations are used for medical purposes. A distinctive
© J.A. Rizaev, Y.Sh.Ruzimurotova, G.A. Khaydarova, 2022.
feature of physiotherapy rooms is the simultaneous operation of several physiotherapy devices, which creates a complex electromagnetic environment.
Galvanisation is the therapeutic application of direct electric current. Galvanisation uses direct current of low voltage (up to 80 V) and low strength (up to 50 mA). External EMF produces conduction current in tissues, which activates local blood flow and increases the content of biologically active substances in tissues. Drug elec-trophoresis is the combined effect of a constant electric field and a drug administered with the help of this field. Drug electrophoresis is often combined with ultrasound therapy (electrophonophoresis), aero- and barotherapy (aeroion electrophoresis) and high frequency magnetic therapy (inductothermoelectrophoresis). They are combined with ultrasonic vibrations and microwave fields that increase permeability of the skin barrier to drugs. The main sources of EMF when working with high-frequency equipment are electrodes and emitters of various types. Personnel protection from electromagnetic non-ionising radiation is achieved by organisational and engineering measures, as well as the use of personal protective equipment (PPE).
Organisational measures include the operation of installations, limiting the time personnel are exposed to EMI. Engineering measures include the use of enclosures, screens to reduce the penetration of EMR into the workplace. Physiotherapy equipment shall be installed in isolated cubicles, with frameworks made of plastic or wooden poles, or metal (nickel-plated) pipes, free from earthing (insulation from walls and floor). No more than one appliance may be placed in the booth.
The dimensions of the cubicle should be 2.0 m high, 2.2 m long and 1.8 m wide. When using devices for inductothermia, microwave therapy and UHF generators with a power of more than 200 W, the width of the cabin must be at least 2 m. Apparatuses for UHF and microwave therapy with remote, including universal arrangement of capacitor plates of emitters, require the organization of specially dedicated rooms or cabins, shielded by a cloth with microwire.
Biological effects of non-ionizing EMR depend on wavelength, generation mode (continuous, pulsed) and conditions of exposure to the human body (continuous or intermittent, general or local).
Critical organs and systems include the central nervous system, visual organ, gonads, hematopoietic system. Biological activity decreases with increasing wavelength. Injuries caused by EMR can be chronic, less often acute. In occupational settings, chronic lesions are more common, detectable after several years of work. The health workers complained of neurological complaints (headaches, increased irritability, fatigue, lethargy, sleepiness, intermittent pain in the heart area). Noise and vibration. In modern conditions, the source of noise and vibration is new types of medical equipment, especially dental equipment. The widespread introduction of high-speed drills, including turbine-type drills, into the practice of dentistry in recent years has led to an increase in high-frequency noise levels in the dentist's workplace. Anecdotal evidence in the literature suggests that a significant proportion of dentists experience left-sided hearing loss after a short period of time since starting work on turbines. Of course, the use of dental equipment is important. Thus, T. Bakacs noted that a significant proportion of dentists in Hungary developed left-sided hearing loss shortly after starting work on turbines. Noise levels in dental surgeries exceeded 85dBA, which combined with high frequencies, created a very dangerous situation for the hearing of the staff. It has been found that the high sounds produced by dental equipment lead to unfavourable changes not only on the part of the hearing organ, but also on the part of the nervous system. Neurosensory hearing loss develops with occupational noise exceeding 80 dBA (classified according to ICD X as H83.3), which may occur in healthcare workers exposed to a variety of noise generating medical equipment.
High-frequency noise is more damaging than low-frequency noise, and hearing loss progresses faster if the noise is impulsive, irregular and nonrhythmic. Vibration and the high degree of psycho-emotional stress that is common in the workplace can also contribute to noise damage.
Conclusions: Thus, the nursing profession has consistently ranked 1-2 in Uzbekistan in terms of occupational diseases over the years. Nursing workers account for more than 10% of all occupational diseases among women. It has been established that the specific nature of medical workers' work is related to exposure to occupational factors that may cause illness and disability and, in some cases, be a direct threat to their lives. Therefore, the study of working conditions and occupational hazards in the working activity of medical workers, the regularities of their impact on health is currently relevant and a priority.
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RIZAEV JASUR ALIMDJANOVICH - MD, professor of Samarkand State Medical Institute.
RUZIMUROTOVA YULDUZ SHOMUROTOVNA - 2nd year master's student of nursing, Department of Public Health and Public Health Management, Samarkand State Medical Institute.
HAIDAROVA GUZAL AZAMOVNA - Teacher at Abu Ali ibn Sino Public Health Technical School in Siab.
