Morbidity with temporary loss of ability to work (LUT)

For qualitative and quantitative assessment of the health status of the population, including the working population, indicators of morbidity, mortality, disability, access to medical care, fertility and others are used. The health status of workers is most fully characterized by morbidity indicators with temporary loss of ability to work (Figure 1.1).

Figure 1.1 - Types and nature of disability

Temporary disability is a human condition caused by illness, injury, poisoning and other reasons in which impairment of body functions is accompanied by the inability to perform work duties and professional activities in normal production conditions for a certain period of time, that is, they are reversible.

The document certifying the fact of VN for workers is a certificate of incapacity for work, which provides grounds for release from work due to VN (legal function), calculation of benefits (financial function), prescribes a certain type of treatment regimen (medical function) and represents the primary document for analysis incidence (statistical function).

Analysis of morbidity with VN can be carried out using two main methodological approaches: using the form of statistical reporting and based on police registration data, each of which has its own advantages and disadvantages. Thus, analysis using the form of statistical reporting allows you to quickly obtain information about the number of cases and days of VN in the context of industries, enterprises, workshops for predetermined classes and groups of diseases, identify the structure and dynamics of morbidity with VUT for a long period and calculate the forecast, determine the damage from labor losses or the effectiveness of the measures implemented. But when using this method, the possibilities for a more in-depth analysis of individual classes and groups of diseases are limited; it does not take into account the influence of gender, age, length of service and other factors on VL.

For the first time in the republic, unified unified methodological approaches to an in-depth interpretative analysis of morbidity with VUT have been substantiated, new statistical methods have been developed for determining the reliability of differences in the indicator of the number of days of VL for the main classes of diseases and in total, two schemes for analyzing VL have been proposed, including for the purposes of social and hygienic monitoring ( SHM), operational control, special scientific research.

Systematization of methodological approaches with bringing quantitative and qualitative characteristics into a single system for further analysis and generalization, as well as modeling cause-and-effect relationships between the levels of labor losses and environmental factors will make it possible to give an objective assessment of the health indicators of workers and justify preventive and health measures.

The scheme for analyzing the VN of workers consists of the following stages:

Setting goals, objectives and justifying the need for research;

Selection of the object of study (workshop, enterprise, professional group) taking into account the factors being studied and eliminated;

Gathering the necessary information, including:

· list of employees;

· information from certificates of incapacity for work;

· data on the state of working conditions, materials studying social and other factors;

· primary processing, summary and preparation of materials for creating a database - statistical processing, logical analysis of data, preparation of findings, conclusions.

The purpose of an in-depth analysis of morbidity with VL is to justify and develop measures to reduce VL and eliminate the causes of increased morbidity levels based on determining the patterns of formation of levels of labor loss among workers, studying the role of working conditions and other risk factors and their impact on VL indicators, identifying priority directions for improving working conditions and improving the health of workers.

The main stages for achieving the goal:

Studying the composition of employees based on professional, length of service and other characteristics;

Identification of the frequency and structure of VN, study of the dynamics of labor losses;

Comparative assessment of morbidity rates of the studied populations;

Establishing a connection between VN and possible risk factors;

Justification and development of health and preventive measures.

The rationale for the need for an in-depth analysis of VN is:

High incidence with VUT;

A sharp increase in VN in general or in individual nosological forms in comparison with previous periods, industry or other indicators;

Increase in occupational pathology;

Increasing the number of workers seeking medical care;

Justification of new or confirmation of existing MPCs, MACs and other regulations;

Development of current and long-term plans for optimizing working conditions based on identifying the role of an unfavorable production environment and other risk factors in the formation of VN;

Determination of economic damage from labor losses or socio-economic effect from previously implemented preventive measures;

Identification of frequently and long-term sick people, their recovery, organization of medical examination;

Timely detection of early effects to prevent chronic diseases and reduce the severity of pathology;

Identification of factors that contribute to improving health and reducing morbidity;

Assessment of the activities of treatment and preventive institutions;

Formation of a database (DB), an automated information processing system (AIPS) on the health status of workers for monitoring purposes.

The optimal period for studying VN is three years. In the absence of the influence of registered outbreaks of infectious diseases, pronounced irregularity of production work (reconstruction, repair work), significant changes in the nature and characteristics of medical care and other uncontrollable factors characteristic or specific to individual years of observation, as well as in the presence of a sufficient number of contingents in groups, analysis incidence with VUT can be carried out over one year.

Increasing the observation period to 5 years or more makes it possible to increase the statistical reliability of the study and makes it possible to perform a more in-depth analysis of VL. But this, on the other hand, increases the labor intensity of the study and creates additional difficulties in identifying the real state of working conditions at the initial period of the study in a retrospective analysis of morbidity with VUT.

Since statistically significant differences in the morbidity levels of the compared groups of workers are the main evidence of the influence of unfavorable working conditions on their morbidity, the correct selection and formation of these groups is of decisive importance. They should differ in working conditions, the influence of which on VN is supposed to be studied, but be equal (or similar) in other factors affecting workers (medical care, travel to work, food, etc.) By forming groups based on professional characteristics, it is necessary to focus not only on the name of the profession, but also take into account specific production conditions, as well as the homogeneity of groups in terms of the rhythm of work, work schedule and number of night shifts, pay and other issues of labor organization. A more complete account of these and other factors when forming homogeneous groups makes it possible to identify reliable differences in smaller teams that may not appear if the homogeneity of the groups is not observed.

An increase in VL indicators with increasing work experience in certain conditions indicates the undoubted influence of working conditions on the health of workers. The influence of working conditions on morbidity can also be judged by the increase in its levels with increasing work experience based on data obtained on the same contingent over several years. (Fig. 1.2.2., Fig. 1.2.3)

Figure 1.2 - Distribution of days of incapacity for work with long-term disability among male workers in the Republic of Belarus by age

Figure 1.3 - Distribution of days of incapacity for work with long-term disabilities among working women of the Republic of Belarus by age

The most specific evidence of the negative impact of unfavorable working conditions on VL indicators can be obtained if general morbidity rates are confirmed and reflected in differences in VL levels for certain groups of diseases or nosological forms characteristic of exposure to a given factor, and they increase with increasing professional experience or increasing intensity influence of the production factor.

Morbidity rates are influenced by the quality of medical care and disability assessment.

Thus, more complete identification and improvement of patients with chronic diseases can lead to a decrease in morbidity rates with VUT, a decrease in exacerbations of chronic pathology, and a reduction in the duration of VL. On the other hand, shortcomings in the work of the examination negatively affect morbidity rates, so it is preferable to select groups to be compared within the service of one medical unit, one health department, and take into account other features of the medical care of the groups being studied.

Section 7

Morbidity with temporary disability and examination in medical institutions

Criteria for assessing morbidity rateswith temporary disability

The incidence of temporary disability is studied among those insured under social insurance (workers and employees) who have the right to receive a certificate of incapacity for work or a corresponding certificate. The certificate of incapacity for work is the main statistical document on the basis of which indicators characterizing this type of morbidity are calculated.

Indicators of morbidity with temporary disability characterize the prevalence and health reasons that are sufficient, in accordance with current legislation, to exempt workers from going to work for a certain period of time and paying them the appropriate benefits. Among these reasons, the main place is occupied by illness, sanatorium treatment for certain diseases, as well as release from work due to a child’s illness and the need to care for him.

This indicator is measured by the number of cases of disability for these reasons and the number of days of disability per 100 workers. The indicator is used mainly in the context of operational analysis of the reasons for absenteeism and the effectiveness of measures to prevent and treat diseases among workers. In this regard, an assessment of direct and indirect economic losses, as well as the state of medical care and sanitary well-being at enterprises and in individual industries, is also carried out.

It is generally accepted that the incidence of illness with temporary disability in the amount of 80-100 cases and 800 - 1000 days per 100 workers reflects the usual epidemic situation and a satisfactory level of health of workers. The spread of the indicator can be quite large - from 40-50 cases and 500-600 days to 150 cases and 1500-1600 days per 100 workers. What matters is the age and gender composition, the general level of health of workers, the complexity and sanitary well-being of production, work schedules, the availability of preferential working conditions, etc. Recently, the level of this indicator has been influenced by underemployment and the possibility of unemployment: the number of cases of requests for medical help in connection with disability is somewhat reduced, but the average duration of the case, characterizing the severity of the disease, increases to an average of 12-13 days. In the structure of causes of morbidity with VUT in the Udmurt Republic, the first three places, both in cases and in days per 100 workers, are occupied by respiratory diseases; "nursing"; diseases of the musculoskeletal system.

Methodology for analyzing morbidity with temporary disability

The incidence of temporary disability is the incidence of that part of the population that works and has the right to compensation for earnings in the event of temporary disability in the form of benefits from the social insurance fund. Its analysis occupies a special place in the work of a doctor due to its high socio-economic significance. This type of morbidity not only reduces the level of health, but also causes great economic damage, which consists of the costs of providing outpatient and inpatient care, treatment in sanatoriums and dispensaries, payment of disability benefits, lost production in material production due to absenteeism and its disorganization and reduction in the volume of services in non-material production.

The search for reserves for reducing morbidity is also extremely relevant because currently, due to unfavorable changes in the age composition of the population, the influx of labor resources is decreasing, and increasing the level of health of workers could provide additional workers to a specific enterprise and the country as a whole.

The level of morbidity with temporary disability is influenced by more than 40 reasons, which can be combined into four large groups:

I. Related to a person and the conditions of his life and behavior:

A. biological (gender, age, heredity, resistance and reactivity of the body);

b. lifestyle, bad habits (alcohol abuse, smoking, drug addiction);

V. level of general and sanitary culture and attitude towards one’s health;

d. living conditions (provision of living space and utilities, hygienic characteristics of the home, etc.);

d. marital status (family composition, way of life and relationships of its members, degree of workload in everyday life).

II. Environmental related:

A. natural and climatic conditions (sharp temperature changes, low or high air temperature, etc.);

b. hygienic characteristics of the environment (pollution of atmospheric air, water, soil, level of street noise, etc.).

III. Related to working conditions:

A. professional conditions and work organization (work culture, shifts, rhythm of safety precautions, etc.);

b. sanitary and hygienic working conditions (noise, vibration, dust, drafts, temperature conditions, etc.);

in the state of consumer services (availability of showers, women’s hygiene rooms, personal protective equipment, special clothing, drinking regime, etc.).

IV. Related to the level of medical care and examination of work ability:

A. organization and quality of medical care;

b. organization and quality of work ability examination;

V. features of the social insurance system and payment of disability benefits.

Analysis of morbidity with temporary disability can be carried out in two directions: according to official state reporting and according to the results of a special in-depth study.

Accounting and analysis according to official statistics

The unit of accounting for morbidity with temporary disability is a case of disability. Records of sick leave issued by doctors are made in the book of registration of certificates of incapacity for work (F No. 036 U).

The data from these documents is used to analyze the dynamics of morbidity and duration of disability both by diagnosis and by individual patients.

Form No. 16-BH “Information on the causes of temporary disability” behind……… year" was approved by Resolution No. 49 of the State Statistics Committee of Russia dated June 27, 1999, the report is compiled by gender and age, according to the lines "Total for diseases", "Total for all reasons", which includes information about abortions, patient care, leave due with sanatorium-resort treatment (without tuberculosis and follow-up treatment for myocardial infarction), exemption from work due to quarantine and bacterial carriage.

A separate line contains data on maternity leave.

The list of diseases corresponds to the International Classification of Diseases, Injuries and Causes of Death, X Revision.

The report (form 16-VN) is filled out by health care institutions of all ministries and departments that provide medical care, treat patients and have the right to issue certificates of incapacity for work.

Information for filling out the reporting form 16-VN in medical institutions is taken from the “Coupon for a completed case of incapacity for work” (form No. 025-9/4-u-96), (Order of the Ministry of Health of the Russian Federation dated October 28, 1996 No. 366 .) or “Book of registration of certificates of incapacity for work” (form No. 36/u) (Appendix 1).

“Coupon for a completed case of temporary disability” - form No. 025 –9/u-96 is filled out by a doctor upon completion of a case of temporary disability according to the “Medical record of an outpatient” - f. 025 -4/у, “Medical card of a university student, student of a secondary specialized institution” - f. 025-3/u, “History of child development” - f.112/u, “Medical record of a patient with a sexually transmitted disease” - f. 065/u, “Medical record of a patient with fungal disease” - f. 065-1/u, “Medical record of a patient with tuberculosis” - f. 081/у, “Individual card for pregnant and postpartum women” - f. 111/у and other medical documentation approved by the Ministry of Health, in which a case of temporary disability is registered.

Procedure for filling out the coupon:

in term 1 - “Last name, first name, patronymic” - the patient’s full surname, first name, and patronymic are written down;

in term 2 - “Gender” is emphasized as “male” or “female”;

in line 3 - “Date of birth” - indicate the day, month, year of birth of the patient;

in line 4 - “Home address” - the patient’s place of residence (registration) is indicated;

in line 5 - “Place of work” - indicate the name of the enterprise where the patient works;

in line 6 - “Final diagnosis” - the diagnosis of the underlying disease (trauma, etc.) that was the main cause of temporary disability is made;

in line 7 - “Disease code” - the diagnosis code of the underlying disease is entered in accordance with the “International Statistical Classification of Diseases and Related Health Problems” X revision.

When determining the underlying disease, the following rules should be followed:

A) in the presence of several diagnoses that have a causal relationship with each other, the diagnosis of the disease that is the cause of the remaining diseases indicated in the final diagnosis should be considered the main one;

B) in case of two or more independent diseases, the most severe and lasting one is considered the main one;

C) if an infectious disease is indicated among the diseases, then it is considered the main one, and of two infectious diseases it is considered an epidemic one;

D) during surgical treatment, the disease that served as the reason for the operation is encrypted;

Line 8 - “Total number of days of incapacity for work in this case” - includes the total number of days of incapacity for work of the patient on all sick leaves for this case of temporary incapacity for work, regardless of which institutions issued them.

A summary based on the “Coupon for a completed case of temporary disability” allows you to draw up the annual form No. 16-VN “Information on the causes of temporary disability for ______ year".

Based on reporting form No. 16-VN, an analysis of the level and structure of temporary disability is carried out both in the context of individual medical institutions and various administrative territories.

The analysis of morbidity with temporary disability begins with the calculation of indicators, since the data in the report are presented in absolute numbers.

First, calculate the morbidity structure or the share of diseases for each line in the total number of all diseases in cases and days of incapacity:

Structure indicators make it possible to identify the leading pathology that shapes the morbidity level. In relation to these diseases, it is necessary first of all to develop and carry out preventive measures.

The average number of employees per month is defined as half the sum of employees at the beginning and end of the month. The average number of employees per year can be determined in two ways:

a) summing monthly data and dividing it by 12;

b) by summing the number of employees at the beginning of each month. including the beginning of January of the following year and dividing by 13.

When determining aggregate morbidity rates for several enterprises (or for several quarters), one must also pay attention to the number of employees. If it is approximately the same, the summary indicator can be obtained as the average of the indicators per 100 employees for each enterprise or quarter. If one of the enterprises differs significantly in the number of employees, then the calculation should be made on the basis of absolute numbers.

The average duration of one case of temporary disability due to illness is calculated by dividing the absolute number of calendar days by the absolute number of cases of temporary disability for this reason. This indicator characterizes the severity of the disease and the quality of the work ability examination.

The listed indicators are calculated for the total line, as well as for other types of disability.

A certain index represents an analysis of the seasonality of incidence:

In addition, it is advisable to highlight the monthly seasonality index (in%):

Im = P x 365 x 100 ,

where P is the number of diseases in a given month

K – number of days in a month

N – total number of diseases per year

These indicators will allow us to identify periods of the year characterized by the highest incidence of illness and injury and plan preventive measures.

No less clear is the definition of this indicator not as a percentage, but as an absolute number of conditional persons who did not work at the enterprise during the year:

Of great interest is also the calculation of the number of days during which the enterprise theoretically did not work during the year due to illness and injury:

And finally, the economic damage caused by morbidity and injury is calculated, which consists of:

Undelivered industrial output is defined as the product of the average output of a worker per day by the number of days of illness with temporary disability.

Funds spent on sick leave payments are calculated by multiplying the average benefit per day by the number of days of temporary disability.

Morbidity with temporary disability occupies a special place in population morbidity statistics due to its high socio-economic significance. Reducing the incidence of workers and employees is a great reserve for increasing labor productivity at any enterprise.

Reducing labor losses contributes to the protection of the health of workers and employees, and also allows saving money on social insurance. Morbidity with temporary loss of ability to work has a feature that distinguishes it from the general morbidity of the population, since not all diseases do not always lead to loss of ability to work. The study and analysis of morbidity with temporary disability does not provide an exhaustive description of the health of workers, however, it makes it possible to identify the impact of morbidity on working ability.

This morbidity may be the result of a violation of the organization of work, chronic overwork, the harmful effects of a complex of production factors, deficiencies in the provision of medical and preventive care, etc. The level and structure of this type of morbidity is influenced by various factors. The incidence of illness with temporary disability has a close connection with the age, gender, professional, length of service of workers, working and living conditions, and the quality of medical and labor examination. In addition, it can be a criterion for the effectiveness of measures of a socio-economic, hygienic and medical nature.

In plans for the socio-economic development of an enterprise, initial data on the incidence of workers with temporary disability are the basis for improving sanitary and hygienic working conditions and improving the quality of medical care.

The unit for recording morbidity with temporary disability is a case of loss of ability to work due to a disease. The accounting document in which each case of such a disease is registered is a certificate of incapacity for work. This document is also a document

ment legal (is the basis for the patient’s failure to fulfill his labor obligations to the employer), financial (on its basis, disability benefits are calculated and paid to the patient within the framework of social insurance) and statistical (when developing certificates of incapacity for work, it is possible to obtain indicators characterizing the incidence of illness with temporary loss of ability to work) .

The reporting form for morbidity with temporary disability is form No. 16-VN. This document is intended for operational purposes of recording and analyzing temporary disability of workers. The specifics of its preparation and the order of presentation are specified in the instructions.

This reporting form contains information on the number of cases and days of temporary disability in absolute numbers. Based on these absolute values, a number of relative and average values ​​can be calculated, allowing comparison of indicators for individual lines (causes of disability), professional groups, time periods, etc.

The main indicators that can be calculated based on the report information are the following:

1. Number of cases of disability per 100 workers: absolute number of cases of disability x 100

average number of employees

Number of days of disability per 100 workers: absolute number of days of disability x 100

average number of employees

3. Average duration of one case of disability: absolute number of days of disability absolute number of cases of disability

4. Morbidity structure indicator:

absolute, number of cases (or d.) easy. according to d. ill. x 100% absolute number of cases (or days) in general for all diseases

These indicators are calculated:

For all reasons (illness, caring for the sick, vacation in connection with sanatorium treatment, quarantine);

By disease;

By disease class;

For certain reasons.

The indicator of the number of cases of disability per 100 workers (frequency indicator) indicates the level of morbidity among workers. The indicator of the number of days of disability per 100 workers characterizes, mainly, the severity of the disease, and also has a certain economic significance. The average duration of a disability case expresses the severity of the disease and the quality of the disability assessment.

When calculating indicators, you should remember that you must use the average annual number of employees, which is defined as half the sum of employees at the beginning and end of the month. The average annual number of employees per year can be determined in two ways:

1) by summing the number of employees at the beginning of each month (including the beginning of January of the next year) and dividing this amount by 13;

2) summing up monthly data on the average number of employees and dividing the sum by 12.

Calculation of morbidity rates of female genital organs should be based on the number of women.

The structure of morbidity allows us to determine the place (significance) of a particular disease among all diseases.

Additionally, to characterize labor losses due to temporary disability, the following indicators can be calculated.

1. The share of those who conditionally did not work during the reporting period (percentage of those who conditionally did not work during the reporting period):

absolute number of days of incapacity x 100%

average annual number of employees x number of calendar days. days report, year

In the absence of data on the number of employees, you can calculate:

2. Number of absences from work per working day:

absolute number of days of incapacity for work

number of calendar days in a year

When performing a comparative analysis of morbidity indicators with temporary disability across enterprises or over time, it should be remembered that the indicators must be calculated on qualitatively homogeneous populations of workers, i.e. comparison of indicators is possible if the enterprises being compared are the same in terms of age, gender, occupation, length of service composition, since these signs affect the level of indicators. If the composition of the workforce is heterogeneous, the use of a statistical method for standardizing indicators is justified.

Analysis of morbidity with temporary disability based on official statistics is limited to a comparison of the most important indicators (cases, days of disability, average duration of the case) by industry, by department of the enterprise, by professional and social groups. A mandatory element of the analysis is a dynamic comparison by year and quarter (comparison with the corresponding quarters of the previous year). When dynamically analyzing morbidity indicators with temporary disability over several years, it makes sense to calculate the average annual indicators and the average annual growth rate of indicators for the analyzed series of years.

Morbidity with temporary disability (TL) occupies a special place in morbidity statistics due to its high economic importance. Morbidity with VUT is one of the types of morbidity according to appealability, and is a priority characteristic of the health status of workers.

The morbidity rate with VUT characterizes the prevalence of those cases of morbidity among workers that resulted in absenteeism from work.

The unit of observation when studying morbidity with VUT is each case of temporary disability due to illness or injury in a given year. The accounting document is a certificate of incapacity for work, which is not only a medical statistical document, but also a legal document certifying temporary release from work, and a financial one, on the basis of which benefits are paid from social insurance funds. In addition to passport data (last name, first name, patronymic, gender, age), the certificate of incapacity for work contains information about the sick person’s place of work, diagnosis and duration of treatment.

The assessment of morbidity with VUT is carried out both according to the generally accepted method based on reports of temporary disability (form No. 16-VN), and according to an in-depth method using the police method. According to the generally accepted methodology, based on data from form No. 16-VN, a number of indicators can be calculated: 1) the number of cases of temporary disability per 100 workers: calculated as the ratio of the number of cases of diseases (injuries) to the average number of workers, multiplied by 100 (on average about 80- 100 cases per 100 workers); 2) the number of days of illness per 100 workers: the ratio of days of illness (injuries) to the number of workers, multiplied by 100 (about 800-1200 per 100 workers); 3) the average duration of one case of PVUT (the ratio of the total number of days of disability to the number of cases of disability) is about 10 days.

When analyzing VUT, the structure of temporary disability in cases and days is determined (first place - diseases of acute respiratory infections, then - diseases of the nervous system and sensory organs, hypertension, diseases of the musculoskeletal system, skin infections, diseases of the digestive system, etc.). All morbidity indicators are assessed by nosological forms (in cases and days per 100 workers) and in dynamics over a number of years. In an in-depth method for studying morbidity with VUT using the police method, a personal, or personal, card is filled out for each worker. The unit of observation in this technique is the worker. When registering morbidity by police, the following are assessed: health index; frequency of diseases (1, 2, 3 times); the proportion of people who are often sick (4 times or more a year) and those who are sick for a long time (more than 40 days).

Based on health groups, workers can be divided into 5 main groups: 1) healthy (who did not have a single case of disability in the year); 2) practically healthy (having had 1-2 cases of disability per year due to acute forms of disease); 3) who had 3 or more cases of disability per year due to acute forms of disease; 4) having chronic diseases, but no cases of loss of ability to work; 5) having chronic diseases and cases of loss of ability to work due to these diseases.

More on the topic Morbidity with temporary disability. Accounting and reporting documentation and evaluation of indicators. Frequency of diseases. Health Index:

1. Statistical population. Accounting characteristics. The concept of continuous and selective research. Requirements for statistical data and the use of accounting and reporting documents

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Temporary disability includes such conditions of the body when disturbances caused by illness and making it difficult to perform professional duties are reversible and transient. The study of morbidity with temporary disability of various contingents of the working population is of great scientific, practical, as well as economic importance.

The characteristics of the work of individual professional groups of engineers have a “specific” impact on their health. Diseases of the cardiovascular system, nervous system, etc. occupy a large proportion in the structure of diseases of employees. The emergence of these diseases is facilitated not only by the modern lifestyle of the urban population, the decrease in the level of physical activity, which is most pronounced in the group of engineering and technical workers, but also by the characteristics of work activity.

We conducted a study of morbidity with temporary disability of engineers and managers of the plant management and main departments of the plant by registering cases and the number of days of temporary disability in special “Cards for the Study of Temporary Disability”. 1261 people were under observation.

The bulk of workers in both groups were people with work experience at the enterprise of 5-9 and 10-19 years - 67.9% and 64.9%, respectively. Among the engineering workers of shop services, there were more people with more than 10 years of work experience (76.0%) than among plant management engineers (61.7%), and with more than 20 years of experience - 26.3% and 16.8%, respectively. When comparing indicators of temporary disability, we took these differences into account and calculated standardized indicators directly by gender and length of service. The composition of plant management engineers by gender and length of service was taken as the standard.

When comparing morbidity levels with temporary disability for all diseases over the 5 years studied, it turned out that they remained higher for engineering and technical personnel of shop services than for engineering and technical personnel of plant management.

Standardization by gender and length of service did not change the ratio of indicators of temporary disability.

Temporary disability, both in the number of cases and by days, in all the years studied was higher among engineering workers of shop services than among engineering workers of plant management. The average level of incapacity for engineers of shop services was 79 cases, 790 days, and for engineers of plant management, respectively, 74 cases and 676 days per 100 workers. It should be noted that as a result of the clinical examination of this contingent carried out under our leadership, the incidence of illness with temporary loss of ability to work has decreased slightly over the indicated years.

The increased incidence of engineering and technical personnel in shop services is explained by less favorable working conditions than in the plant management. Engineers and heads of shop services are in the shops from 15 to 40% of their working time, and foremen and site managers are in the shops up to 60% of their working time.

Engineering and technical workers in workshops are likely to develop diseases characteristic of their respective industries. Thus, in engineering workshops where there is a high concentration of coolant aerosols in the air of the working area, medical examinations revealed a tendency to diseases of the upper respiratory tract (pharyngitis, laryngitis, etc.). Among the causes of loss of ability for engineers and managers, influenza, acute respiratory viral infections, pneumonia and other respiratory diseases occupy a significant place. Of the listed nosological forms, the incidence rates of pneumonia and chronic respiratory diseases are slightly higher among engineers and heads of shop services - 2.27 cases and 41.8 days per 100 workers versus 1.4 cases and 25.7 days of disability among engineers and plant management managers ( Table 1).

Standardization by gender and length of service did not change the ratio of indicators. The composition of the engineering and technical personnel of the plant management was adopted as the standard. Thus, for influenza, temporary disability when standardized by gender among engineers of shop services was 11.4 in cases, 64.5 in days, and 12.3 and 67.6 in days, respectively. The picture is the same for pharyngitis and tonsillitis, pneumonia and chronic respiratory diseases, diseases of the gastrointestinal tract, sensory organs, nerves and peripheral ganglia and some other diseases.

Table 1

Indicators of temporary disability of engineers and managers of plant management and shop services standardized by gender and length of service (per 100 employees)

	Name tion diseases	Groups	Temporary disability, in cases
			intensive strong display- tel	standard- tiz. By semi	standard- tiz by length of service
1	Flu	Plant- management	8,6	8,6	8,6
		Shop services	10,2	11,4	12,3
2	Acute forms tonsil- lita	Plant- management	6,1	6,1	6,1
		Shop services	6,8	7,3	8,2
3	Pneumo- nii and chronic nothing concern a lion. organ- new breath Hania	Plant- management	1,4	1,4	1,4
		Shop services	2,3	2,6	2,7
4	Diseases stomach and 12 fingers guts	Plant- management	2,1	2,1	2,1
		Shop services	3,2	3,3	3,5
5	Hyperto- nic disease	Plant- management	2,0	2,0	2,0
		Shop services	1,1	1,5	1,6
6	Diseases organs feelings	Plant- management	1,7	1,7	1,7
		Shop services	2,5	2,7	2,8
7	Ischemi- cheskaya disease hearts	Plant- management	0,7	0,7	0,7
		Shop services	1,1	1,8	1,9
8	Diseases nerves and periphery ric ganglia	Plant- management	0,25	0,25	0,25
		Shop services	4,86	5,3	5,5

Thus, the incidence of illness with temporary disability of engineering and technical personnel of shop services for the above nosological forms of diseases, even with the same gender and length of service, would be higher than the engineering and technical personnel of the plant management, as evidenced by standardized indicators.

We further studied temporary disability from a professional perspective. The company's engineering staff was divided into 3 professional groups: managers, engineers and craftsmen.

The age-sex characteristics of these groups have already been discussed in the section characterizing the incidence of diseases according to the data on appeal.

The study of temporary disability of persons belonging to the specified professional groups showed that the highest average long-term levels were identified in the group of engineers, in second place were foremen, and in third place were managers (Table 2).

table 2

Temporary disability of engineers and managers (per 100 employees)

№ pp	Professional nal groups	Intensive indicators		Standardized indicators
		in cases	in days	V cases			V days
				By semi	By length of service		By semi	By hundred zhu
	Managers
	Engineers

Standardization of indicators of temporary disability by gender and age showed that with the same age and sex composition as managers, the temporary disability of engineers and foremen would be even higher. The higher level of temporary disability of persons of these professional groups compared to managers is explained by the significant frequency of influenza, ARVI and colds, the spread of which is due to large crowding in office premises, where there is less than 4.5 m2 of space per worker. The reason for the low rates of temporary disability among managers is their high responsibility and lack of time, which is why they do not always seek medical help and, as a rule, do not issue a certificate of incapacity for work.

In this study, we were primarily interested in the frequency of temporary disability due to cardiovascular diseases. In the structure of the causes of temporary disability of managers for this group of diseases, the first place belongs to vascular diseases (40.9% of cases and 40.5% of days), the second place belongs to hypertension (29.1% of cases) and coronary disease (21.3% of days) . The main reasons for temporary disability of engineers also turned out to be vascular diseases (40.5% of cases and 27.0% of days), hypertension (35.5% and 25.4%, respectively). Temporary disability of masters is caused by hypertension (60.0% of cases and 66.9% of days), as well as rheumatism (23.3% and 14.5%, respectively).

As can be seen from table. 3, temporary disability of managers due to cardiovascular diseases in cases is more than twice as high, in days - 2.5-4.9 times, than the same indicator for engineers and craftsmen. Managers suffer from vascular diseases, hypertension and coronary heart disease more often and longer than engineers and craftsmen. The average duration of one case of coronary heart disease among managers stands out especially sharply - 38.9 days, while this figure was 17.4 days for engineers, 18.5 days for foremen, although the number of cases of temporary disability of managers and engineers is approximately the same. This indicates the significant severity of coronary heart disease among managers.

Table 3

Temporary disability of various groups of managers and engineers for cardiovascular diseases (per 100 employees)

№