Morbidity with temporary disability (TS)

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

Figure 1.1 - Types and nature of disability

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

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

The analysis of morbidity with LN can be performed using two main methodological approaches: according to the form of statistical reporting and based on police records, each of which has its own advantages and disadvantages. Thus, analysis according to the form of statistical reporting allows you to quickly obtain information on the number of cases and days of VL in the context of industries, enterprises, workshops for predetermined classes and groups of diseases, identify the structure, dynamics of incidence with VUT over 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 of a deeper analysis of individual classes and groups of diseases are limited; it does not take into account the influence of gender, age, work experience, and other factors on VL.

For the first time in the republic, unified unified methodological approaches to an in-depth interpretive analysis of morbidity with TD were substantiated, new statistical methods were developed for determining the reliability of differences in the indicator of the number of days of LT for the main classes of diseases and in total, two schemes for analyzing LT were proposed, including for the purposes of social and hygienic monitoring ( SGM), 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 of cause-and-effect relationships between levels of labor loss and environmental factors will make it possible to give an objective assessment of indicators of the health status of workers, to justify preventive and health measures.

The scheme for analyzing the VL of workers consists of the following steps:

Setting goals, objectives and justification of the need for research;

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

Collection of necessary information, including:

list of employees;

information from sick leave certificates;

data on the state of working conditions, materials for the study of social and other factors;

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

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

The main stages for the implementation of the goal:

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

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

Comparative assessment of morbidity rates of the studied contingents;

Establishing a connection between VL and possible risk factors;

Substantiation and development of health and preventive measures.

The justification for the need for an in-depth analysis of VL are:

High incidence with VUT;

A sharp increase in VL in general or for individual nosological forms compared with previous periods, industry or other indicators;

Growth of occupational pathology;

Increasing the appeal of workers for medical care;

Substantiation of new or confirmation of existing MPCs, MPCs and other regulations;

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

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

Isolation of frequently and long-term sick people, their recovery, organization of clinical examination;

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

Identification of factors that promote health, reduce morbidity;

Evaluation of the activities of medical institutions;

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

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

Increasing the follow-up period to 5 years or more improves the statistical significance of the study and makes it possible to perform a more in-depth analysis of VL. But this, on the other hand, increases the complexity of the study, creates additional difficulties in identifying the real state of working conditions for the initial period of the study in a retrospective analysis of the incidence of TD.

Since statistically significant differences in the levels of morbidity in the compared groups of workers are the main evidence of the influence of unfavorable working conditions on their morbidity, the correct choice and formation of these groups is of decisive importance. They should differ in terms of working conditions, the impact of which on VL is supposed to be studied, but be equal (or similar) in terms of other factors affecting workers (medical care, travel to work, food, etc.) 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 rhythm of work, work schedule and number of night shifts, pay and other issues of labor organization. A more complete consideration of these and other factors in the formation of homogeneous groups makes it possible to reveal significant differences in smaller groups, which may not appear if the groups are not homogeneous.

The growth of VL indicators with an increase in work experience under 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 growth of its levels with an increase in work experience based on data obtained on the same contingent in dynamics over several years. (Fig. 1.2.2., Fig. 1.2.3)

Figure 1.2 - Distribution of days of disability with TD among working men of the Republic of Belarus by age

Figure 1.3 - Distribution of days of disability with TD among working women of the Republic of Belarus by age

The most concrete 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 the impact of this factor, and they grow with an increase in professional experience or an increase in intensity. the impact of the production factor.

The quality of medical care and examination of disability has an impact on morbidity rates.

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

Section 7

Morbidity with temporary disability and examination in medical institutions

Criteria for assessing incidence rateswith temporary disability

Morbidity with temporary disability is studied among those insured by social insurance (workers and employees) who are entitled to receive a certificate of incapacity for work or a corresponding certificate.

Indicators of morbidity with temporary disability characterize the prevalence and causes on the part of health, sufficient in accordance with the current legislation to release workers from going to work for a certain period and pay them appropriate benefits. Among these reasons, the main place is occupied by diseases, sanatorium treatment for certain diseases, as well as release from work in connection with the illness of the child 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 employees. The use of the indicator occurs mainly in the order 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 is also made of direct and indirect economic losses, as well as the state of medical care and sanitary well-being at enterprises and in individual industries.

It is generally accepted that the incidence of 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 part-time employment, the possibility of unemployment: the number of cases connection with disability is somewhat reduced, but the average duration of the case, which characterizes the severity of the disease, increases to an average of 12-13 days. In the structure of the 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.

Method of analysis of morbidity with temporary disability

Morbidity with temporary disability is the incidence of that part of the population that works and is entitled to compensation for earnings in case 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, shortfalls in 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 to reduce the incidence is also extremely relevant because at present, due to unfavorable shifts in the age composition of the population, the influx of labor resources is decreasing, and an increase in the health level of workers could provide, as it were, additional workers for a particular enterprise and the country as a whole.

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

I. Associated with a person and the conditions of his life and behavior:

a. biological (sex, age, heredity, resistance and reactivity of the organism);

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

v. the level of general and sanitary culture and attitude to one's health;

d. living conditions (provision of housing and communal amenities, hygienic characteristics of the dwelling, etc.);

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

II. Environmental related:

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

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

III. Related to working conditions:

a. professional conditions and organization of work (work culture, shifts, rhythmic safety measures, etc.);

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

in the state of consumer services (presence of showers, women's hygiene rooms, personal protective equipment, overalls, drinking regimen, etc.).

IV. Related to the level of medical care and examination of working capacity:

a. organization and quality of medical care;

b. organization and quality of the examination of working capacity;

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

The analysis of morbidity with temporary disability can be carried out in two directions: according to official state reports 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. Accounting for sick leaves issued by doctors is carried out in the register of sick leave certificates (F No. 036 U).

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

Form No. 16-BH "Information on the causes of temporary disability" per……… year” approved by Decree No. 49 of the State Statistics Committee of Russia dated June 27, 1999, the report is compiled by sex and age, according to the lines “Total for diseases”, “Total for all reasons”, which includes information on abortions, patient care, leave due to with sanatorium treatment (without tuberculosis and aftercare of myocardial infarction), release from work due to quarantine and bacteria carrier.

A separate line highlights data on maternity leave.

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

The report (f. 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 disability certificates.

Information for filling out the reporting form 16-VN in medical institutions is taken from the "Talon for a completed case of disability" (f. No. 025-9 / 4-y-96), (Order of the Ministry of Health of the Russian Federation dated 10.28.96 No. 366 .) or "Book of registration of sick leave" (f. No. 36 / y) (Appendix 1).

“Coupon for a completed case of temporary disability” - form No. 025-9 / y-96 is filled out by a doctor at the end of a case of temporary disability according to the “Outpatient Medical Card” - f. 025 -4 / y, “Medical card of a university student, student of a secondary specialized institution” - f. 025-3 / y, “History of the development of the child” - f.112 / y, “Medical record of a patient with a venereal disease” - f. 065 / y, "Medical record of a patient with a fungal disease" - f. 065-1 / y, "Medical record of a patient with tuberculosis" - f. 081 / y, "Individual card of a pregnant woman and a puerperal" - f. 111 / y and other medical documentation approved by the Ministry of Health, in which a case of temporary disability is registered.

How to fill out the ticket:

in term 1 - “Last name, first name, patronymic” - the full surname, first name, patronymic of the patient are recorded;

in term 2 - "Gender" is underlined respectively "male" or "female";

in line 3 - "Date of birth" - the date, month, year of birth of the patient is indicated;

in line 4 - "Home address" - the place of residence (registration) of the patient is indicated;

line 5 - "Place of work" - indicates the name of the enterprise where the patient works;

in line 6 - "Final diagnosis" - the diagnosis of the underlying disease (injury, etc.) is put down, which served as the main cause of temporary disability;

in line 7 - "Code of the disease" - the code of the diagnosis of the underlying disease is affixed 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, the main one should be considered the diagnosis of the disease, which is the cause of the other diseases indicated in the final diagnosis;

B) with two or more independent diseases, the most severe and long-term one is considered the main one;

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

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

Line 8 - “Total number of days of disability in this case” - includes the total number of days of disability of the patient on all sick leave for this case of temporary disability, regardless of which institutions they were issued.

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

Based on the 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 given in absolute figures.

First, the structure of morbidity or the proportion of diseases for each line in the total number of all diseases in cases and days of disability is calculated:

Structure indicators make it possible to identify the leading pathology that forms the incidence rate. In relation to these diseases, it is first of all necessary 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 the monthly data and dividing it by 12;

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

When determining the consolidated incidence rates for several enterprises (or for several quarters), one should also pay attention to the number of employees. If it is approximately the same, a summary indicator can be obtained as an 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 a given reason. This indicator characterizes the severity of the disease and the quality of the examination of working capacity.

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 allocate a monthly seasonality index (in%):

Im = P x 365 x 100 ,

where P is the number of cases in a given month

K is the number of days in a month

H - the total number of diseases per year

These indicators will make it possible to establish the periods of the year characterized by the highest morbidity and injuries and to plan preventive measures.

No less clear is the definition of this indicator not as a percentage, but in the 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 morbidity and injuries:

And, finally, the economic damage caused by morbidity and injuries is calculated, which is added up:

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

Funds spent on sick leave payments - by multiplying the average allowance per day by the number of days of temporary disability.

Morbidity with temporary disability occupies a special place in the population's morbidity statistics due to its high socioeconomic 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 saves money on social insurance. Morbidity with temporary disability has a feature that distinguishes it from the general morbidity of the population, since not all diseases and do not always lead to disability. The study and analysis of morbidity with temporary disability do not provide an exhaustive description of the health of workers, however, they allow us to identify the impact of morbidity on working capacity.

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, shortcomings in the provision of medical and preventive care, etc. Various factors influence the level and structure of this type of morbidity. Morbidity with temporary disability has a close relationship with the age, gender, professional, length of service of workers, working and living conditions, the quality of medical and labor expertise. In addition, it can be a criterion for the effectiveness of socio-economic, hygienic and medical measures.

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

The unit of accounting for morbidity with temporary disability is a case of disability due to the disease. The record document in which each case of such a disease is recorded is a certificate of incapacity for work. This document is also a document

legal (is the basis for the patient's failure to fulfill 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 sick leave sheets, you can get indicators characterizing the incidence with temporary disability) .

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. Features of its compilation 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, it is possible to calculate a number of relative and average values that allow comparison of indicators for individual lines (reasons for disability), occupational groups, periods of time, etc.

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

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

average number of employees

Number of days of incapacity for work per 100 employees: absolute number of days of incapacity for work x 100

average number of employees

3. Average duration of one case of incapacity for work: absolute number of days of incapacity for work absolute number of cases of incapacity for work

4. Indicator of the structure of morbidity:

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

These indicators are calculated:

For all reasons (diseases, patient care, vacation in connection with sanatorium treatment, quarantine);

By diseases;

According to the classes of diseases;

For separate reasons.

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

When calculating indicators, it should be remembered that it is necessary to 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) summing up 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 the monthly data on the average number of employees and dividing the sum by 12.

Calculation of incidence rates of female genital organs should be made to the number of women.

The structure of morbidity allows you to determine the place (significance) of a 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 were conditionally unemployed for the reporting period (the percentage of those who were conditionally unemployed for the reporting period):

absolute number of days of disability x 100%

average annual number of employees x number of calendars. days report, years

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

2. The number of absenteeism per working day:

absolute number of days of incapacity for work

number of calendar days in a year

In a comparative analysis of morbidity rates with temporary disability by enterprises or in dynamics, it should be remembered that the indicators should be calculated on qualitatively homogeneous populations of employees, i.e., comparison of indicators is possible if the compared enterprises are the same in terms of age, gender, professional, length of service. composition, since these features affect the level of indicators. If the composition of employees is heterogeneous, the use of the statistical method of standardizing indicators is justified.

The analysis of morbidity with temporary disability on the basis of official statistics is limited to comparing the most important indicators (cases, days of disability, average duration of the case) by industry, by enterprise departments, by professional and social groups. An obligatory element of the analysis is a dynamic comparison by years, quarters (comparison with the corresponding quarters of the previous year). In a dynamic analysis of morbidity rates with temporary disability over several years, it makes sense to calculate the average annual rates and the average annual rate of growth (growth) of indicators for the analyzed series of years.

Morbidity with temporary disability (TSD) occupies a special place in the statistics of morbidity due to its high economic significance. Morbidity with VUT is one of the types of morbidity in terms of negotiability, it is a priority characteristic of the state of health of workers.

Morbidity with VUT characterizes the prevalence of those cases of morbidity among workers that resulted in absence from work.

The unit of observation in the study of morbidity with VUT is each case of temporary disability due to a disease or injury in a given year. The accounting document is a certificate of incapacity for work, which is not only a medical statistical, but also a legal document certifying temporary release from work, and financial, 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 disability certificate contains information about the place of work of the sick person, 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 the data of form No. 16-VN, a number of indicators can be calculated: 1) the number of cases of temporary disability per 100 employees: calculated as the ratio of the number of cases of diseases (injuries) to the average number of employees, multiplied by 100 (on average, about 80- 100 cases per 100 workers); 2) the number of days of MTD per 100 employees: the ratio of days of morbidity (injury) to the number of employees multiplied by 100 (about 800-1200 per 100 employees); 3) the average duration of one case of MTD (the ratio of the total number of days of disability to the number of cases of disability) is about 10 days.

In the analysis of MTD, 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 in days per 100 employees) and in dynamics over a number of years. With an in-depth method for studying the incidence with VUT by the police method, a front, or personal, card is filled in for each worker. The unit of observation in this technique is the working one. In the case of police records of morbidity, the following are evaluated: health index; multiplicity of diseases (1, 2, 3 times); the proportion of those who are often ill (4 times or more a year) and those who are ill for a long time (more than 40 days).

By health groups, workers can be divided into 5 main groups: 1) healthy (who did not have a single case of disability in a year); 2) practically healthy (who had 1-2 cases of disability per year due to acute forms of diseases); 3) who had 3 or more cases of disability in a year due to acute forms of diseases; 4) having chronic diseases, but not having cases of loss of ability to work; 5) those who have chronic diseases and who had 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:

Statistical aggregate. Account signs. The concept of continuous and selective research. Requirements for the statistical population and the use of accounting and reporting documents

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

Features of the work of individual professional groups of engineers have a "specific" impact on their health. A large share in the structure of diseases of employees is occupied by diseases of the cardiovascular system, the nervous system, etc. The emergence of these diseases is facilitated not only by the modern lifestyle of the urban population, a decrease in the level of physical activity, which is most pronounced in the engineering and technical group, but also by the peculiarities of labor activity.

We conducted a study of the incidence of temporary disability of engineers and managers of the plant management and the main workshops 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 the employees in both groups were persons with 5-9 and 10-19 years of work experience at the enterprise - 67.9% and 64.9%, respectively. Among the engineering and technical personnel of shop services, there were more persons with work experience of more than 10 years (76.0%) than those of plant management engineers (61.7%), and those with more than 20 years of experience - 26.3% and 16.8%, respectively. When comparing indicators of temporary disability, we took into account these differences, calculated standardized indicators in a direct way by gender and length of service. The composition of the engineering staff of the plant management by gender and length of service was adopted as a standard.

When comparing the levels of morbidity with temporary disability for all diseases over the 5 years studied, it turned out that they remained higher among the engineering workers of shop services than those of the factory management engineers.

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

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

The increased morbidity of engineering and technical workers in shop services is explained by less favorable working conditions than in factory management. Engineers and heads of shop services from 15 to 40% of the working time are in the shops, and foremen and section chiefs - up to 60% of the working time.

The engineering and technical workers of the shops are likely to develop diseases that are characteristic of the respective industries. Thus, in engineering and mechanical workshops, where the concentration of coolant aerosols in the air of the working zone is high, medical examinations revealed a tendency to diseases of the upper respiratory tract (pharyngitis, laryngitis, etc.). Influenza, acute respiratory viral infections, pneumonia and other respiratory diseases occupy a significant place among the causes of disability for engineers and managers. Of the listed nosological forms, the incidence rates of pneumonia and chronic respiratory diseases are slightly higher among engineers and managers 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 staff of the plant management was adopted as a standard. So, for influenza, temporary disability with standardization by gender for engineering and technical personnel of shop services was 11.4 in cases, 64.5 in days, and 12.3 and 67.6 in terms of length of service, respectively. The same picture 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

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

	Name- ing diseases	Groups	Temporary disability, in cases
	Name- ing diseases	Groups	inten- gray show- body	standard- tyz. on semi	standard- teez by seniority
1	Flu	Plant-up management	8,6	8,6	8,6
1	Flu	Shop services	10,2	11,4	12,3
2	Acute forms tonsil- litas	Plant-up management	6,1	6,1	6,1
2	Acute forms tonsil- litas	Shop services	6,8	7,3	8,2
3	Pneumo- nii and chro- nothing care- a lion. org- new dy- chania	Plant-up management	1,4	1,4	1,4
3		Shop services	2,3	2,6	2,7
4	Diseases stomach and 12-finger. guts	Plant-up management	2,1	2,1	2,1
4	Diseases stomach and 12-finger. guts	Shop services	3,2	3,3	3,5
5	Hyper- nic disease	Plant-up management	2,0	2,0	2,0
5	Hyper- nic disease	Shop services	1,1	1,5	1,6
6	Diseases bodies feelings	Plant-up management	1,7	1,7	1,7
6	Diseases bodies feelings	Shop services	2,5	2,7	2,8
7	Ishemi- chesky disease hearts	Plant-up management	0,7	0,7	0,7
7	Ishemi- chesky disease hearts	Shop services	1,1	1,8	1,9
8	Diseases nerves and periphery rical ganglia	Plant-up management	0,25	0,25	0,25
8	Diseases nerves and periphery rical ganglia	Shop services	4,86	5,3	5,5

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

Further study of temporary disability was carried out by us in a professional context. The engineering staff of the enterprise was divided into 3 professional groups: managers, engineers and foremen.

The age-sex characteristics of these groups have already been mentioned in the section characterizing the incidence according to the data of negotiability.

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

table 2

Temporary disability of engineers and managers (per 100 employees)

№ pp	Professional- groups	Intensive indicators		Standardized indicators
		in cases	in days	v cases		v days
				on semi	on seniority	on semi	on one hundred zhu
	Leaders

	Engineers

Standardization of indicators of temporary disability by sex 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, SARS and colds, the spread of which is due to high crowding in the office, where one worker has less than 4.5 m2 of area. The reason for the low rates of temporary disability among managers is a great responsibility, lack of time, in connection with which 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 - to hypertension (29.1% of cases) and coronary disease (21.3% of days) . Vascular diseases (40.5% of cases and 27.0% of days), hypertension (respectively 35.5% and 25.4%) were also the main causes of temporary disability of engineers. Temporary disability of foremen is due to hypertension (60.0% of cases and 66.9% of days), as well as rheumatism (respectively 23.3% and 14.5%).

As can be seen from Table. 3, the temporary disability of managers due to cardiovascular diseases in cases is more than twice as high, in days - 2.5-4.9 times higher than the same indicator for engineers and craftsmen. Managers get sick more often and longer than engineers and foremen with vascular diseases, hypertensive and coronary heart disease. 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 a significant severity of coronary heart disease in managers.

Table 3

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

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