Vibration disease (2) - Abstract. Study of harmful production factors in the workplaces of seafarers. What is vibration. The effect of vibration on the body

INTRODUCTION

CHAPTER I. LITERATURE REVIEW.

1.1. The influence of climatic-geographical and social-environmental conditions of sailors’ activities on the incidence of illness among sailors.

1.2. The role of psycho-emotional stress in the formation of cardiovascular diseases among sailors.

1.3. Epidemiology of risk factors for cardiovascular diseases among seafarers.

CHAPTER II. MATERIALS AND METHODS OF RESEARCH.

CHAPTER III. DYNAMICS OF INCIDENCE WITH TEMPORARY LOSS OF WORK CAPACITY IN SAILORS OF THE NORTH BASIN OVER A 10-YEAR PERIOD.

CHAPTER IV. ANALYSIS OF THE DYNAMICS OF DESCRIPTION OF NORTHERN BASIN SAILING STAFF FROM THE FLEET ACCORDING TO CARDIOVASCULAR DISEASES IN 1980-2000.

CHAPTER V. ANALYSIS OF THE DYNAMICS OF SAVING LIMITATIONS FOR CARDIOVASCULAR DISEASES IN 1980-2000.

CHAPTER VI. ORGANIZATION OF EARLY PREVENTION, MEDICAL INTERVENTION AND REHABILITATION OF PERSONS SUFFERING WITH CARDIOVASCULAR DISEASES AMONG THE FLATING STAFF OF THE NORTHERN WATER BASIN.

Introduction of the dissertationon the topic "Public health and healthcare", Moser, Adolf Albertovich, abstract

The work activity of seafarers is associated with exposure to a wide range of occupational hazards: noise, vibration, electromagnetic fields, pitching, frequent changes in time and climate zones, etc. The work of a seafarer in conditions of a long stay on board a ship, information deficiency and monotony of the environment, separation from home and families, intensive professional loads during shift work inevitably lead to a decrease in the level of health of the crew.

The work of seafarers differs from the work of other professional groups of the population due to the specific conditions of maritime service. The professional activity of seafarers rightly falls into the category of work performed in extreme conditions. The body of workers in maritime professions is affected by a complex of general biological manifestations of the World Ocean and the technical features of navigation equipment. Features of the organization of the labor process during the voyage period lead to overstrain of adaptation systems, and unfavorable factors of the eco-system “man-ship-environment”, independently or complexly affecting the seaman’s body, cause significant changes in it, including pathological ones.

According to annual medical examinations of seafarers in the Northern Basin, it was found that 26% of those examined were found to have chronic diseases. At the same time, since 1995, the proportion of absolutely healthy sailors has decreased from 45% to 30%. This situation is aggravated by the growing technical wear and tear of the fleet and a reduction in the number of crews.

Therefore, the study of the epidemiology of morbidity with temporary disability, disability of seafarers, factors influencing restrictions on seafarers and decommissioning of sailors from the fleet, as well as analysis of the characteristics of the quality of life of seafarers is relevant and practically significant in order to improve the organization of medical care for workers in the Northern Basin. In the current conditions, there is a need to carry out a set of measures aimed at preserving the professional health of seafarers, preventing general and occupational diseases, and medical rehabilitation of water transport workers.

PURPOSE AND OBJECTIVES OF THE STUDY:

The purpose of the study is to study the influence of cardiovascular pathology on the incidence of illness with temporary disability and restrictions on work in the crew and decommissioning from the fleet in order to develop a set of therapeutic and preventive measures among sailors, fishermen and river workers of the Northern water basin.

To achieve this goal, the following tasks were set:

1. To analyze changes in the structure of morbidity with temporary disability among water transport workers in the Northern water basin over a 10-year period (from 1990 to 2000).

2. To analyze the prevalence of morbidity, the dynamics of restrictions and decommissioning from the fleet of the Northern Water Basin for cardiovascular diseases over a 20-year period (from 1980 to 2000).

3. To determine the dynamics of disability due to cardiovascular diseases among the sailors of various fleets of the Northern water basin in 1980-2000.

4. Develop a set of preventive, therapeutic and organizational measures of a medical and social nature to improve the health of water transport workers and preserve their labor potential.

SCIENTIFIC NOVELTY OF THE WORK

For the first time, the incidence of temporary disability among water transport workers in the Northern Basin was analyzed over a 10-year period; dynamic changes in cardiovascular diseases were identified, which were the cause of restrictions on the crew and professional unfitness among representatives of the merchant, fishing and river fleet of the European North of Russia in 1980 -2000

The nosological structure of cardiovascular diseases, which most often led to restrictions, and subsequently to decommissioning from the fleet, was analyzed and a comparative analysis of the prevalence of these diseases was carried out, both among representatives of various fleets and individual ship specialties.

For the first time, cardiovascular disease prevention programs have been developed and implemented, aimed at water transport workers in the Northern Basin.

A new comprehensive approach to carrying out preventive measures for persons suffering from cardiovascular diseases has been developed, and the need for early diagnosis of cardiovascular pathology in water transport workers has been substantiated in order to reduce morbidity and disability.

SCIENTIFIC AND PRACTICAL SIGNIFICANCE OF THE WORK

A database has been created that can be used for analysis and subsequent work in the field of social and hygienic research regarding the prevalence of cardiovascular diseases and their impact on the professional suitability of sailors in the Northern Basin.

The results of the study were used in the activities of various treatment and preventive institutions of the Russian Federation: Siberian District Medical Center of the Ministry of Health of the Russian Federation, Novosibirsk (implementation certificate dated 04/21/2003), West Siberian Medical Center of the Ministry of Health of the Russian Federation, Omsk (implementation certificate dated 03/03/2003 ), Far Eastern District Medical Center of the Ministry of Health of the Russian Federation, Vladivostok (act of implementation dated April 14, 2003), Murmansk Clinical Complex of the National Medical and Surgical Center of the Ministry of Health of the Russian Federation, Murmansk (act of implementation dated 14.05.2003), branch "Vologda Hospital" of the Northern Medical Center named after N.A. Semashko of the Ministry of Health of the Russian Federation, Vologda (implementation certificate dated May 20, 2003).

Based on the results of the study, a system for identifying a “risk group” for the development of cardiovascular diseases was developed, implemented at the North Central Basin Clinical Hospital named after N.A. Semashko (implementation act dated December 2, 2002). The introduction of an early intervention program for “at-risk groups” allows for dynamic monitoring and treatment and rehabilitation measures in relation to the threatened population.

The results of the study were used in writing the “Guide to medical and social work in gerontology” and the “Guide to marine medicine.”

The screening procedure created during the study makes it possible to more effectively, in comparison with methods used so far, identify a “risk group” for the development of cardiovascular pathology among water transport workers. The conducted research substantiates the feasibility of introducing a number of medical rehabilitation programs.

The data obtained in the work forms the basis for the following orders for the North Central Basin Clinical Hospital named after. N.A. Semashko in 1999 - 2003: “On additional examination of sailors over 30 years old for the purpose of early detection of lipid disorders” (order No. 11 of 1999), “On the implementation of a program for the prevention of coronary heart disease among sailors of the Northern water basin” ( order No. 5 of March 17, 2001), “On the organization of schools for patients with arterial hypertension and chronic heart failure on the basis of the Central Clinical Hospital named after. N.A. Semashko" (order No. 21 of December 6, 2001), "On measures to prevent risk factors for cardiovascular diseases in sailors, fishermen and river workers on voyages and the inter-voyage period" (order No. 6 of 2002), “On the creation of a physical rehabilitation center on the basis of the Vodnikov polyclinic in Arkhangelsk” (order No. 2 of January 21, 2003).

BASIC PROVISIONS FOR PROTECTION: 1. There are significant differences in the structure and level of morbidity with temporary disability among the sailors of various fleets of the Northern water basin.

2.3a period from 1980 to 2000. a negative trend was identified in the frequency of decommissioning from the fleet due to cardiovascular diseases among sailors of the Northern water basin.

3. Active early diagnosis of cardiovascular diseases among the sailors of the Northern water basin is necessary using modern medical technologies, screening procedures and objective methods of functional diagnostics.

4. The created step-by-step system for early diagnosis of people suffering from cardiovascular diseases can be recommended as a model for implementation in various areas of production and transport (aviation, railway, road and others).

APPROBATION OF THE DISSERTATION The results of the study were reported at the joint board of the Ministry of Health of the Russian Federation and the Ministry of Transport of the Russian Federation (Moscow, 1998), the scientific session of the Northwestern Branch of the Russian Academy of Medical Sciences (Arkhangelsk, 2000), the X International Symposium “Ecological and physiological problems of adaptation” (Moscow, 2001) , International Conference “Ecology and Health in the 21st Century” (Ulyanovsk, 2001), All-Russian Congress of Cardiologists (Moscow, 2001), 1st International Congress on Marine Health (Philippines, 2001), International Congress “Marine Medicine” (St. Petersburg, 2002), International Conference “Marine Medicine in the New Millennium” (Arkhangelsk, 2002)

PUBLICATIONS

Based on the research materials, 12 printed works were published, including 5 journal articles, the chapter “Organization of the Marine Medical Service” in the “Manual on Marine Medicine” (Arkhangelsk, 1998) 3 methodological recommendations approved by the Ministry of Health of the Russian Federation. The research materials were used in writing the monographs: “Some indicators of the body functions of sailors and fishermen of the North” (Arkhangelsk, 1999) and “Guide to medical and social work in gerontology” (Arkhangelsk, 2000).

STRUCTURE AND SCOPE OF THE DISSERTATION The dissertation is structured according to a monographic plan and consists of an introduction, a review of scientific literature, a description of the material and research methods, 4 chapters of own research, as well as a conclusion.

Conclusion of the dissertation researchon the topic "Structure of morbidity with temporary disability and the influence of cardiovascular pathology on the professional suitability of the sailors of the Northern water basin"

5. The results of the study showed that in half of the cases (49.6%) decommissioning from the fleet due to cardiovascular diseases was carried out in connection with coronary heart disease with angina pectoris in combination with hypertension. This combination of diseases was significantly more common among workers of the river shipping company, compared to merchant seamen and fishermen, which is explained by the fact that the latter are more often residents of other regions and seek medical help at their place of residence, and not at their home port, and sometimes even hide the manifestation of the disease.

6. The fact of earlier appearance of restrictions on cardiovascular diseases among river fleet workers has been established. Thus, the length of service of merchant marine sailors who were found to have limitations due to cardiovascular diseases for working as sailors was 22.0 ± 0.22 years, for fishermen 17.1 ± 0.27 years, for river workers 15.7 ± 0.86 year (R<0,001). В то же время анализ инвалидизации списанного плавсостава по флотам выявил, что работники речного флота достоверно чаще (Р<0,005), чем работники торгового и рыбопромыслового флотов, списывались из плавсостава без определения группы инвалидности (в 67,6%, 62,% и 58,2% соответственно). По-видимому, это также связано со спецификой работы работников речного флота, а именно более короткими рейсами, большей доступностью медицинской помощи, возможностью динамического наблюдения.

7. Significant differences were identified in the average number of persons with restrictions for working as sailors among representatives of various fleets per 1000 workers. This indicator turned out to be maximum among fishermen (45.1 ± 2.8 people), minimum among river workers (16.12 ± 3.9 people), which is explained by the geography of vessel voyages among representatives of these fleets, and, first of all, the lack of voyages among river workers in tropical countries.

8. An analysis of the structure of the most common restrictions on cardiovascular diseases among sailors in the Northern Basin showed that in the vast majority of cases among all professional groups of sailors, restrictions on flights to tropical latitudes prevail. At the same time, these restrictions were encountered significantly more often among the deck and engine crew than among the navigators (R<0,001 и Р<0,01 соответственно), у палубной команды достоверно чаще, чем у машинной команды (Р<0,05).

1. In order to study the prognostic assessment of risk factors and subsequent monitoring, carry out preparatory work to create a register of patients from among the sailors of the Northern Basin. The register includes all seafarers with risk factors for the development of cardiovascular diseases.

2. Introduce mandatory identification of risk factors for coronary heart disease into the practice of medical commissions of seafarers. In particular, to determine an accessible and informative indicator - the waist/hip index, and also to study total blood cholesterol in sailors over 30 years of age, with the aim of early detection of lipid changes. When identifying two or more risk factors for IHD in sailors (in order to identify hidden IHD), it is mandatory to conduct bicycle ergometer tests.

3. When carrying out measures for the primary prevention of cardiovascular diseases among sailors, special attention should be paid to river fleet workers, as they are the most at risk of developing cardiovascular diseases.

4. Taking into account the specifics of the work of workers in the commercial and fishing fleets (long voyages, less availability of medical care, the impossibility of constant dynamic monitoring by shop doctors, the absence of ship doctors on most ships), introduce radio and telecommunication technologies into the work of the SMC named after N.A. Semashko,

5. Due to the high prevalence of arterial hypertension among sailors, extend the school’s experience in preventing arterial hypertension to all maritime medical centers of the Russian Federation.

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1

An analysis of the structure of occupational diseases of river transport workers in the Russian Federation was carried out, on the basis of which the predominant harmful production factors in the river fleet workplaces were identified, namely: increased noise and vibration, insufficient natural and artificial lighting, indoor microclimate parameters, electromagnetic fields, tension and severity labor process. The actual values ​​of these factors were determined at the workplaces of captain-mechanics, ship systems mechanics, and motorists of the river fleet of the Omsk region. Studies have shown widespread exceeding of permissible standards by factors: industrial noise, microclimate, tension and severity of the labor process. The causes and consequences of this situation are analyzed. The effectiveness of personal protective equipment for ship personnel and their actual compliance with the requirements of industry standards have been studied. Measures are proposed to improve the working conditions of water transport workers.

working conditions

water transport

harmful production factors

river fleet

microclimate

illumination

vibroacoustic factor

tension of the labor process

severity of the labor process

1. Denisova E.S., Butorina N.V. Injuries in water transport // Equipment and technology of petrochemical and oil and gas production: materials of the 6th international. scientific-technical conf. (Omsk, April 25–30, 2016). – Omsk: Omsk State Technical University Publishing House, 2016. – P. 239–240.

2. On approval of the Methodology for conducting a special assessment of working conditions, the Classifier of harmful and (or) hazardous production factors, the report form for a special assessment of working conditions and instructions for filling it out: Order of the Ministry of Labor of Russia No. 33n dated January 24, 2014 [Electronic resource] . – Access mode: https://www.consultant.ru/document/cons_doc_LAW_158398 (date of access: 07/10/2016).

3. Manual for technical operation of inland water transport vessels. – M.: According to Volg.-Rkonsult, 2002. – 64 p.

4. SanPin 2.2.4.548-96.2.2.4. Physical factors of the production environment. Hygienic requirements for the microclimate of industrial premises. Sanitary rules and regulations. (approved by Resolution of the State Committee for Sanitary and Epidemiological Supervision of the Russian Federation dated 01.10.1996 No. 21) [Electronic resource]. – Access mode: http://www.consultant.ru/document/cons_doc_LAW_93768 (date of access: 07/10/2016).

5. Saritsky S.P. On the main results of the control and supervisory function in sea and river transport // Transport safety and technology. – 2015. – No. 2 (41). – pp. 58–63.

6. Fort E., Ndagire S., Gadegbeku B., Hours M. Working conditions and occupational risk exposure in employees driving for work // Accident Analysis & Prevention. – Vol. 89. – 2016. – P. 118–127.

One of the most important directions of social policy in Russia, in accordance with Art. 37 of the Constitution of the Russian Federation is to ensure optimal working conditions that meet the safety and hygiene requirements of workers in various industries. However, the issues of improving working conditions in the water transport of the Russian Federation have been studied rather poorly. An analysis of the literature showed that works devoted to the problem of studying working conditions and health status of water transport workers were carried out in 1960 - 1980. Scientists studied these issues: N.K. Kulbovsky, V.G. Nakushin, V.D. Royus, B.B. Belogolovsky, L.N. Nadevich, A.B. Razletova and others. Meanwhile, today the working conditions of water transport workers not only are not improving, but have become even more unfavorable due to significant wear and tear of the fleet. For example, in 2013, the average age of a sea vessel in the Russian Federation was 28 years, the age of river vessels was 32-33 years. In recent decades, there have been only a few research works in the field of labor protection in water transport of the Russian Federation, devoted to economic and social processes in the sphere of labor, health protection and psychological adaptation of workers. Seafarers, while on board a ship, are exposed to harmful production factors not only during the work shift, but also during rest, due to the specific features of this industry. In this regard, the purpose of the study was to determine the actual values ​​of noise levels, vibration, lighting, microclimate parameters, electromagnetic fields, tension and severity of the labor process at crew workplaces.

Materials and research methods

Studies of working conditions in water transport were carried out using the example of the river fleet of the Omsk region. The vibroacoustic factor was measured using a sound level meter, an ASSISTANT SIU 30 V3RT vibrometer, illumination - with a TKA-PKM model 09 luxmeter, microclimate parameters - with an MES-200 Meteometer, to assess the intensity of the labor process, an S-01 electronic stopwatch was used, to assess severity - a stanovoi dynamometer DS- 500, tape measure, laser range finder, protractor 4UM, pedometer ShEE-01. The measurements were carried out according to standard methods. Statistical processing was carried out using Student's t-test.

Research results and discussion

The figure contains information on the number of occupational diseases and accidents at water transport enterprises in the Omsk region. Illustration of the above data for 2012-2015. shows the presence of a problem associated with the actual working conditions of water transport workers, which affects the decrease in productivity of production activities, and also entails additional costs for eliminating the consequences (treatment, rehabilitation, training of new personnel). In water transport organizations, mainly only cases with severe and fatal outcomes were registered. The absence of accidents with easy outcomes indicates that such incidents that occurred on ships are not investigated and are actually hidden.

The existing problem requires attention to improving the working conditions of water transport workers based on updating and supplementing previously developed organizational and technical measures, taking into account the climatic characteristics and economic capabilities of the region.

The most common diseases among ship workers are colds. The structure of morbidity with temporary disability is mainly dominated by colds, leading to damage to the ear, throat, nose, and lungs; the main cause of these diseases is drafts. Currently, according to the procedure for conducting a special assessment of working conditions, microclimate parameters at the navigator’s workplace are not assessed. According to the classifier of harmful and (or) dangerous production factors (Appendix No. 2 to the order of the Ministry of Labor of Russia No. 33n dated January 24, 2014), the microclimate of the production environment and the labor process is identified as a harmful and (or) dangerous factor in workplaces located in closed production premises that contain technological equipment that is an artificial source of heat and (or) cold (with the exception of climate control equipment that is not used in the technological process and is intended to create comfortable working conditions). At the same time, studies have shown significant deviations in air temperature, as well as air speed in the working areas of the crew. In accordance with the energy consumption of the body at the workplace, the category of work of navigators is equated to IIa. For this category of work, the permissible air temperature standards in the warm period of the year are 18-27 °C, while the measured temperature in the wheelhouse, galley, near the main and auxiliary diesel generators varied from 14 to 30 °C and was close to external meteorological conditions, which is associated with the peculiarities of the organization of the labor process on the ship: in the work areas of the crew, the doors are often open for a long time. All this leads to colds, which become chronic due to the lack of opportunity to receive qualified medical care in a timely manner.

Number of accidents and occupational diseases among seafarers in the Omsk region

Table 1

Results of vibration measurements at crew workplaces

table 2

Results of measurements of noise levels at crew workplaces

Table 3

Results of illumination measurements at crew workplaces

In second place in the number of diseases among sailors is complete or partial hearing loss. Sources of increased noise and vibration on a ship are the main engine, diesel generators, engine-steering complex, and ventilation system. Water transport uses powerful industrial engines, which are a source of broadband noise. Measurements of vibroacoustic factors on ships showed that the vibration level complies with regulatory requirements, and significant excesses are observed in the noise level (Tables 1, 2).

Long-term exposure to vibroacoustic factors on the human body leads to a decrease in hearing and visual acuity, increased blood pressure, disorders of the cardiovascular system, pathological changes in the joints, and also affects the nervous system. The situation is aggravated by the technical wear and tear of ships and a reduction in the number of crews.

The actual illumination at the crew's workplaces complies with regulatory requirements (Table 3), but they do not take into account poor visibility during watchkeeping in the evening and night hours. It is not always possible to clearly see obstacles on the shipping route with the help of searchlights and locators; in the morning hours, fog often rises on the river and visibility is significantly reduced.

The impact of electromagnetic fields on navigators occurs when working with a locator on a radio range finder and with a radio station. The studies carried out did not reveal any excess of permissible standards.

Seafarers are characterized by sedentary postures, and during preventive maintenance and repair they are forced to work with great physical exertion, which determines harmful conditions based on the severity of the labor process. Prolonged physical stress leads to the development of fatigue, which is manifested by a decrease in human activity and performance.

Limited space, limited communication, monotony of work, routine, high degree of responsibility, lack of time for thinking and making decisions when passing difficult sections of the river create increased work tension for navigators. Water transport workers must have a number of qualities: stability of attention and the ability to distribute it simultaneously to several objects, the ability to switch attention from one object to another, the ability to quickly analyze several options in difficult working conditions, a stable psyche, intuition, and logic. Also, while on watch, they have to process a large amount of heterogeneous information related to navigation safety issues, and provide all types of control over the ship, crew and cargo. All this contributes to neuropsychic overload. The work of a navigator, in terms of its intensity, belongs to the highest category of complexity. The navigator ensures trouble-free operation of the vessel. In this regard, the quality of professional training is very important, preferably using modern simulators; As a result of training, the navigator must have skills (i.e., skills brought to automaticity) in navigation safety.

It can also be noted that the appearance of diseases such as dermatitis, diseases of muscles, bones and joints can occur as a result of insufficient use of personal protective equipment (PPE). According to industry standards (Order of the Ministry of Health and Social Development of Russia dated June 22, 2009 N 357 (as amended on February 20, 2014) “On approval of the Standard Standards for the free issuance of special clothing, special footwear and other personal protective equipment to workers engaged in work with harmful and (or) dangerous working conditions, as well as for work performed in special temperature conditions or associated with pollution"), crew members must be given a certain list of PPE and special clothing, however, not all vessels of water transport enterprises of the Omsk region comply with the requirements of industry standards in full.

Conclusion

Thus, we can note a significant increase in the number of occupational diseases in water transport caused by unfavorable working conditions and wear and tear of vehicles. There is a widespread excess of permissible standards for factors: industrial noise and microclimate. The specific operating conditions in this industry require further improvement in the field of occupational safety management system. Regular medical examination is of great importance, which is aimed at monitoring and preventing occupational diseases of water transport workers. Examination and permission to work should be carried out by specialized medical institutions focused on the specific working conditions of water transport workers. It is also necessary to equip ships with more modern means of collective and individual protection.

Bibliographic link

Denisova E.S., Butorina N.V. RESEARCH OF HARMFUL PRODUCTION FACTORS AT THE WORKPLACES OF BOATING STAFF // International Journal of Applied and Fundamental Research. – 2016. – No. 8-4. – P. 495-498;
URL: https://applied-research.ru/ru/article/view?id=10109 (access date: 02/01/2020). We bring to your attention magazines published by the publishing house "Academy of Natural Sciences"

Abstract of the dissertation on the topic "Working conditions and health status of seafarers"

As a manuscript

KONOVALOV Yuri Vasilievich

WORKING CONDITIONS AND HEALTH STATE OF SEAMEN (using the example of vessels of OJSC "Far Eastern Shipping Company")

Vladivostok, 2000

The work was carried out at the Far Eastern State Technical University.

Scientific supervisors:

Doctor of Technical Sciences, Professor Korotkoe V.I. Doctor of Medical Sciences, Professor Sheparev A.A.

Official opponents:

Doctor of Technical Sciences, Professor Stepanova I.P. Candidate of Technical Sciences Kiku P.F.

Lead institution:

Center for state sanitary and epidemiological surveillance of transport (water and air) in the Far Eastern region.

The defense will take place on December 26, 2000 at 10 a.m. at a meeting of the dissertation council D 064.01.02. at the Far Eastern State Technical University at the address: 690950, Vladivostok, GSP, st. Pushkinskaya, 10.

The dissertation can be viewed in the university library.

Scientific secret (dissertation)

Lushpei V.P.

GENERAL DESCRIPTION OF WORK

Relevance of the problem. The modern development of the fleet is inextricably linked with solving the problem of preserving and strengthening the health of sailors, improving the conditions of their work, life, and recreation. The most important condition for preserving the health of seafarers is to ensure an “optimal living environment on the ship.” In this case, the ship must be considered as an artificial, ecologically closed system that provides the crew with a long active existence.

The human body during navigation is simultaneously affected by a complex of interrelated environmental factors of varying levels and nature (climatic conditions of the navigation area, microclimate of ship premises, noise, vibration, electrostatic radiation, electromagnetic radiation, harmful substances in the air, microflora of the premises, psychophysiological factors and etc.). .The number of ship environmental factors can reach several dozen. Man ultimately reacts to the environment as a whole. Therefore, the criterion reflecting the influence of the ship environment on the human body is the level of the worker’s functional state and his health [L.M. Manevich, 1978, 1999; E.F. Pisarenko, V.N. Timofeev, 1997].

Currently, there is an unsatisfactory state of working conditions and a high level of occupational morbidity among maritime transport workers. The intensification of labor on a voyage is increasing. There is poor quality of preliminary and preliminary medical examinations, a reduction in medical positions on ships, leading to a decrease in the quality of medical care or its complete absence. Vessels of outdated designs, with expired service life, are used. These circumstances lead to deterioration of the living environment on ships and pose a threat to the health of workers. At the same time, there are few scientific research works devoted to a comprehensive hygienic assessment of working conditions and the study of the health status of seafarers and modern conditions, and the information available on them is often contradictory. The foregoing substantiates the relevance of conducting scientific research devoted to further study of the complex of factors that shape living conditions on ships.

Goal of the work. Develop a modern system of science-based measures to prevent the adverse effects of fastors in the ship environment

on the human body to maintain the health and high performance of sailors.

Research objectives:

■ - to provide a scientific basis for the system of preventive measures and recommendations for occupational safety and health of workers on naval vessels in the modern period.

Research methods included hygienic, psychophysiological, sociological (questionnaires and interviews), scientific-statistical methods using a computer and analytical.

Working in hazardous production conditions contributes to the development of changes in the health status of seafarers, determines the structure of production-related and occupational morbidity, and increases the risk of possible work-related injuries;

The state of working conditions and health of ship specialists justifies the need to organize a system of labor protection and health of seafarers, the main goal of which is to create safe working conditions that eliminate or minimize the risk of an employee receiving an occupational disease or accident, preserving the life and health of ship specialists.

Scientific novelty of the work. In the conditions of the Far Eastern region, a comprehensive sanitary and hygienic assessment of working conditions, an analysis of the health status and occupational injuries of specialists working on sea vessels was carried out. The leading harmful production factors have been identified, and the specific characteristics of occupational and production-related morbidity have been determined.

For the first time, an assessment of the natural resistance of the sailors’ body, as well as an analysis of individual risk factors, was given. On this basis, a system of occupational safety and health for seafarers has been justified and developed.

The practical value of the work is that, based on a comprehensive assessment of working conditions and the health status of seafarers, a system of labor protection and health of persons working on sea vessels has been proposed, which will ensure working conditions that meet the safety requirements, which will help preserve the life and health of sea workers transport.

The proposed conclusions and recommendations are used by the Department of Labor, Employment and Demographic Policy of the Primorsky Krach Administration; administration of the Far Eastern Shipping Company company; TsGSEN in transport (water and air) in the Far Eastern region to formulate a policy in the field of labor protection of maritime transport workers, to plan and implement measures to improve the working conditions and safety of seafarers, medical care and rehabilitation of ship special equipment. Fragments of the dissertation are used when giving lectures and conducting practical classes at the Department of Medical Labor of VSMU.

Approbation of work. The main provisions of the dissertation work were reported and discussed at the XXXX scientific and technical conference of teachers and researchers of DVVIMU im. adm. Nevelskoy (Vladivostok, 1986); at the All-Union Conference "Ocean Man" (Vladivostok, 1988); at the scientific conference "Hygiene of long voyages" (Leningrad, 1989); XI International Symposium on Marine Medicine (Poland, Gdynia, 1989); anniversary scientific conference "Medical and social problems of public health in the Far East" (Vladivostok, 1991); thematic scientific and practical conference "Current issues of hygiene and ecology of transport" (Ilkch2vsk, 1992); scientific and technical honorary conference "Primorskie Dawns" (Vladivostok, 1998); scientific and technical conference "Vologdinsk readings. Ecology and life safety" (Vladivostok, 1999); at the scientific and practical conference “Primorskie Dawns - 99” (Vladivostok, 1999); at the Far Eastern regional scientific and practical koi-fereshshi “Modern aspects and problems of labor protection, life safety”

teloyustn in fishery organizations of the Far Eastern basin-99" (Vladivostok, 1999); at the conference “Ecology, life safety, labor protection and sustainable development of the Far Eastern territories” (Vladivostok, 2000); at regional meetings with government experts on working conditions in municipalities of the Primorsky Territory 1992-2000; at the meetings of the Interdepartmental Co.::;ss:;;; on labor protection in the Primorsky Territory 1995-2000.

Publications. Based on the results of dissertation research, 16 printed works were published.

Scope and structure of the dissertation. The dissertation is presented on /^ pages, consists of an introduction, six chapters, a conclusion, conclusions, recommendations, an appendix, illustrated with 5 tables, 1 diagram. The bibliography includes 240 titles.

An analysis of the literature indicates a large number of works devoted to the problem of studying the living conditions and health level of sailors. But, basically, these works were carried out in the 60-80s. There are few scientific studies devoted to the comprehensive hygienic assessment of working conditions and analysis of the health status of seafarers in modern conditions, and the information available in them is often contradictory. There is no such work on the Far Eastern Shipping Company, which currently plays a significant role in the development of the Russian economy. Far Eastern Shipping Company is one of the largest companies in Russia and occupies a significant place in cargo transportation on the vast territory of the Pacific coast. Currently, the company has 90 ships of various series and types, which employ about 8.5 thousand sailors. The socio-economic transformations of recent years have undoubtedly had an impact on the state and development of the maritime fleet. All this justifies the need to conduct a new scientific study devoted to the assessment of the ship environment and the health status of seafarers in the modern period, with the subsequent development of a system of scientifically based measures to prevent adverse effects

factors of the ship environment to maintain the health and high performance of seafarers.

To achieve this goal, a comprehensive hygienic assessment of the working conditions of seafarers was carried out using the example of vessels of the Far Eastern Shipping Company company. In total, the study included 47 vessels belonging to various structural types: container ships, dry cargo ships, refrigerated ships, timber carriers, universal ships, etc. It was established that the living conditions on sea vessels are formed under the influence of a complex of physical and chemical factors, which are often interrelated and can enhance each other's adverse effects. Thus, the microclimate of ship premises is determined by external meteorological conditions, the presence and absence of heated or cold surfaces of equipment and fences, and the condition of sanitary facilities (ventilation, heating, air conditioning systems). The results of our studies showed that the microclimate parameters at the main workplaces of the surveyed ships varied significantly and, according to Guideline 2.2.755.99 “Gen-Gieshespesky assessment criteria and classification of working conditions according to indicators of harmfulness and danger of factors of the working environment, severity and intensity of the labor process)) were rated as acceptable or harmful degrees 1-3. Unfavorable microclimatic conditions were mainly determined by deviations from the norms of temperature and relative air humidity. In rooms where, due to special guest organization of the labor process, doors are often open for a long time (wheelhouse, etc.), the microclimate parameters were close to external meteorological conditions. In the cold season of the year, the air temperature in workplaces was often recorded here below the lower permissible limit, in the warm season - above the upper permissible limit. In the power department, mechanical workshop, electrical workshop, galley and some other ship rooms, the air temperature significantly exceeded the maximum permissible limit. In addition, in the galley, in the power department, the intensity of infrared radiation exceeded the established standard. TNS-iidsks in the power department and in the galley was 22.8° N - 25.4° N. Based on the requirements of Guideline 2.2.755-99, the working conditions of workers in these premises for the time being in the production microclimate are assessed as harmful (class 3, degrees 1-3). Oshosi-

The body air humidity in the ship's premises was also subject to significant fluctuations and amounted to 35.0-100.0%. The air mobility at the workplaces of the surveyed ships generally corresponded to the standard values ​​and did not exceed 0.1-0.2 m/s, with the exception of those rooms where the type of activity required keeping doorways open for a long time. In residential and public premises, microclimate parameters, as a rule, met the requirements of current sanitary standards. An important fact is that when sailing in northern latitudes, sailors are subject to significant fluctuations in atmospheric pressure, frequent fog, strong winds, and snowfalls. In addition to this, the low solstice and a large number of cloudy days reduce to a minimum the possibility of using natural ultraviolet radiation, which can lead to ultraviolet starvation. The foregoing requires the mandatory organization of measures to prevent light starvation on sea vessels.

The actual values ​​of the natural light coefficient in the majority of the surveyed ship premises met the requirements of hygienic standards. The levels of measured artificial lighting at almost all workplaces were 1.5-3.5 times lower than normal and, in accordance with the requirements of R 2.2.755-99, industrial lighting conditions were assessed as harmful (class 3) 1-2 degrees. Due to the fact that in a number of rooms on ships (for example, in the energy department) there is no natural sunlight, the insufficiency of artificial lighting should be considered as an extremely unfavorable production factor. It is known that a long stay in conditions of artificial lighting contributes to the deterioration of the visual analyzer, a decrease in the overall performance of a person, and leads to an increase in neuro-emotional stress, which negatively affects the reliability of the work of watchmen. At the same time, insufficient lighting is one of the causes of industrial injuries. In the residential and public areas of the courts, artificial illumination was close to normal.

The hygienic assessment of the content of harmful chemicals in the air of workers' premises turned out to be most significant during the examination of the energy department. painting room, welding station and some other premises. Yes, in the air

In the working area of ​​the power departments there are harmful substances that have a highly targeted effect (nitrogen oxide, carbon monoxide) and carcinogenic effects (benzopyrene). In the air of the working area of ​​the welding station, substances with acute effects (carbon monoxide, nitrogen dioxide, manganese) and allergenic effects (chromium oxide, iron oxide) are found. Acetone, etc. is detected in the painting room. The concentration of harmful substances, as a rule, does not exceed the maximum permissible concentration. In accordance with the requirements of R 2.2.755-99 for the content of harmful substances in the air of the working area, working conditions are assessed as acceptable. The exception was certain workplaces in the painting room, energy department, and welding station. Conducting special studies in residential and public premises of courts did not reveal the presence of harmful chemicals in them.

The main sources of noise production in ship premises are main engines, auxiliary diesel generators, fans, various auxiliary systems and units, ship signals, etc. Most often, during our studies, increased noise levels were recorded in the power department, ref. department , tiller, etc. It must be emphasized that in residential and public premises sound pressure levels also exceeded standard levels. The most unfavorable conditions in terms of industrial noise parameters were found in the power department. The noise here is, as a rule, constant, broadband. Actual sound pressure levels in octaves bands with geometric mean frequencies of 31 - 8000 Hz exceeded the standardized levels by 4-34 dB. The study of the spectral characteristics of noise revealed the predominance of mid- and high-frequency components. Sound levels at the main workplaces exceeded the maximum permissible by 10-29 dBL. In accordance with the requirements of R 2.2.755-99, in terms of the level of industrial noise, working conditions in the energy department were classified as class 3 (harmful) degrees 1-3. In residential and public premises, we recorded increased noise levels at medium and low frequencies.

The study and analysis of vibration parameters on ships made it possible to identify vibration levels in certain ship rooms that exceeded hygienic standards. In accordance with the requirements of R 2.2.755-99 regarding the level of industrial vibration, working conditions are classified as class 3 (harmful) degrees 1-3. In residential and commercial

In public rooms, minor vertical and horizontal vibrations were detected, the magnitude of which changed simultaneously with a change in the engine operating mode. The highest parameters were observed in the aft cabins. The foregoing indicates that the impact of noise and vibration on a seafarer’s body occurs not only in the workplace, but also in public and public premises, which allows us to consider these factors not only as industrial, but also domestic, inherent in the ship’s environment.

The main sources of electromagnetic radiation (EMR) on sea vessels should be considered navigation equipment, radio transmitters, general radio communications, etc. The measurements made it possible to establish that on most ships the levels of RF and microwave EMR, as a rule, meet sanitary requirements. Literature data indicate that exceeding hygienic standards can occur during the operation of satellite communication stations, as well as in conditions of cross-irradiation of ship radars (ice pilotage, ships following in a convoy, etc.) [L.M. Matsevich, 1978, 1999].

Our research and analysis of semi-pedestrian materials allowed us to establish that the most unfavorable indicators of working conditions occur on ships of the “bulk carrier” and “container ship” type. Working conditions on ships of the “universal”, “container ship”, “cargo and passenger”, “timber carrier” types are somewhat better, but also very harmful to the health of workers. The worst working conditions (and this does not depend on the type of vessel) are in the power department. The main occupational hazards in this department are heat:. The hollows have a microclimate caused by significant heat generation from operating mechanisms, insufficient artificial lighting in the absence of natural lighting, polluted air with fuel combustion products, high levels of noise and vibration. Mechanical and electrical workers are exposed to elevated temperatures and insufficient lighting. Harmful factors that can have a negative impact on the health of those working in the navigation, helmsman and navigation chalk cabins include microclimate parameters, which will depend on the navigation area, and lighting conditions. In radio rooms, as a rule, one observes a “desperate microclimate”, which is caused by the release of heat from heated, superheated equipment, insufficient artificial lighting and

exceeding permissible noise levels. When analyzing data on assessing the working conditions of galley workers, it should be noted that there is contact with significant heat releases in the presence of pronounced radiant heat, levels of artificial lighting are higher than standard values. Those working in painting rooms are adversely affected by the components of paints and varnishes and some other factors. Thus, the majority of specialists working on sea vessels are exposed to the adverse effects of a complex of physical and chemical factors, which can affect their health and labor productivity. This justifies the need for further development and implementation of a set of organizational, sanitary, technical, technological and other measures. It is known that the most effective way to “fight” a harmful factor is to normalize its level, bringing the actual parameters of its action into line with the normative ones. One of the leading harmful factors on sea vessels is noise. Its levels are especially high in the energy department, which is determined by the close location of the diesel generator. We have carried out developments to install a sound-absorbing bulkhead separating the bottom sol generator area from the rest of the energy compartment. Thus, two branches will be created. It is proposed to install a sound-absorbing cladding on the bulkhead (slabs such as “Acmigran”, “Lkminit”, mats made of super-thin fiberglass, mats made of super-thin basalt fiber). Calculations have shown that with the implementation of these measures, noise levels in the high-frequency range will decrease by 19 dB, which will significantly affect the improvement of working conditions and increase productivity.

A hygienic assessment of the factors of the labor process, carried out in accordance with the requirements of R 2.2.755-99, made it possible to establish the following. For all representatives of the command staff (captain, assistant captains, mechanics), the working conditions in terms of tension indicators are characterized as harmful (grade 3 ) 2nd degree - highly stressful work. The intensity of work is caused mainly by intellectual, sensory, emotional stress, as well as the peculiarities of the work regime. The importance of nervous-emotional stress is especially great, due to frequent stressful situations and the specifics of the work of sea transport ( personal risk, responsibility for safety crews degree of responsibility

for the result of one’s own activities, the significance of the error). High intellectual loads are determined by the content, complexity of the work, the need to perceive signals (information) and evaluate them, and the nature of the work performed (work under time pressure). Sensory loads are characterized by long-term concentrated observation, a large number of objects of simultaneous observation, the need to monitor the screens of video terminals, and load on the auditory analyzer. The actual duration of the working day is 10-11 hours, there are irregular shifts and night shift work.

Among the representatives of the rank and file, the working conditions in terms of stress indicators were characterized as harmful (3 grades) of the 1st degree (for a sailor, mechanic, electrician) or as acceptable (for a cook, bartender). The intensity of the work of sailors and mechanics is determined by the nature, complexity, monotony and fairly high emotional stress.

It must be especially emphasized that during a long flight, as a rule, there is a significant restriction or monotony of the body’s usual irritability. The specific condition in this case is boredom, a decrease in the level of motivation, depressed mood and increased anxiety, which in the future can lead to the emergence of various neuropsychic disorders of ship specialists. Our survey of 100 people using a specially designed questionnaire allowed us to establish that after three months of continuous work at sea, sailors have a pronounced development of processes of decreased performance, instability of emotional-emotional behavior. normal state, increased anxiety, signs of astheia (hunger pains, dizziness, etc.). After continuous work for 5 months, the development of astheno-vegetative disorders is noted, and in some ship specialists - a neurosis-like state.

In terms of severity, the working conditions of the chapntan, his assistants, the chief mechanic and mechanics were assessed as acceptable. However, long-term restriction of functional loads can lead to a significant decrease in muscle tone, to the development of detraining of a number of organs and systems and a noticeable decrease in performance. This is indirectly indicated by the materials we received during a sociological survey of command personnel. Literary data indicate changes in the first foreign functions nervous and endocrine systems (fatigue,

weakening of memory, increased number of errors, sleep disturbances). All of the above is especially important in the light of our assessment of the work intensity of the command staff and the data obtained on significant emotional, intellectual and sensory stress.

The work of orderlies, bartenders, and cooks, according to severity indicators, is rated as harmful 1-2 steppes!. This was determined by the physical dynamic load, the mass of the load lifted and moved manually, the number of stereotypical working muscles, the magnitude of the static load, the working posture, and body tilts. Sailors have hard work of the 2nd degree, which is primarily due to the mass of the cargo lifted and moved manually.

So, a comprehensive hygienic assessment showed that the leading unfavorable production factors on ships should be considered noise, vibration, microclimate parameters, lack of lighting, tension and severity of labor. In general, in accordance with the requirements of R 2.2.755-99, the working conditions of seafarers were assessed as harmful (class 3) degrees 2-4. However, it is necessary to point out that p R 2.2.755-99 does not have criteria for assessing such components of living conditions on ships as the macroclinmatic conditions of the area ><лавгитя, постояшюе изменении в течение рейса часовых и климатических поясов, судовая качка. Показатели оценки тяжести и напряженности трудового процесса также не учитывают особенности работы моряков (например, психофизиологические особенности функционирования замкнутых коллективов, гиподинамию, гипокинезию и др.). Помимо этого, с использованием указанного документа, возможно объе:спп5но оценить лишь условия труда, но не условия обитания на судах. В то же время, как мы уже подчеркивали, в условиях рейса комплекс неблагоприятных факторов действует на человека не только в период производственной деятельности, но и во время сна или отдыха и т.п. Следовательно, необходима разработка отраслевого документа, позволяющего осуществлять комплексную гигиеническую оценку всех параметров, формирующих именно судовую среду или условия обитания на судах. В целом выявленные условия чруда и обитания на морских судах требуют дальнейшей научной разработки, организации и внедренит системы мероприятий по их охране и оптимизации.

We assessed the health status of ship specialists on the basis of an analysis of the final acts based on the results of periodic medical examinations.

medical examinations, analysis of occupational morbidity, assessment of the immunosuppression of seamen and analysis of individual risk factors. It was established that for the period from 1995 to 2000. Every year, based on the results of medical examinations, 7-15 people (0.1-0.3 per 100 workers) were identified with suspected occupational disease or occupational intoxication. All persons with suspected occupational disease were sent for examination and clarification of the diagnosis to the Regional Center for Occupational Pathology, where, as a rule, the diagnosis of occupational disease was confirmed. In the structure of the pathology, the diagnosis of sensorineural hearing loss predominated (75%), and approximately 10% each accounted for cochlear neuritis and vegetative-sensory polyneuropathy. It is noteworthy that patients often had grade III-IV hearing loss, that is, severe impairment of the auditory analyzer. In addition, there was a suspicion of obliterating endarteritis, obliterating atherosclerosis of the arteries of the lower extremities, varicose veins of the lower extremities and some other diseases. All victims were male. The age distribution made it possible to identify a gradual increase in the proportion of people with occupational diseases with increasing age: 16.6% at the age of 40-49 years; 33.2% aged 50-59 years and 50.3% aged 6069 years. Distribution by length of service allowed us to establish a similar trend. Among the patients, there were 16.6% with 16-20 years of experience, 33.2% with 21-25 years of experience and 50.3% with 26-30 years of experience. Professional affiliation was presented as follows: 52.9% - mechanics, 35.7. % - motors, 11.4% - others (sailors, electricians, etc.) The leading harmful production factors that caused occupational diseases were noise and general vibration. The emergence of occupational diseases was facilitated by the design imperfection of the workplace and the non-use of personal protective equipment. All patients lost their ability to work in their profession. In addition, as a result of medical examination of seafarers, 300-700 people were identified annually (5.08.0 per 100 workers) with general diseases detected for the first time. In the structure of nayulogin, changes from the auditory analyzer predominated (15-30.0%). Specific aes of pathology from the cardiovascular system, nervous system, gastrointestinal tract, visual analyzer and other systems and

organs was approximately the same and amounted to 3-10%. Analysis of the distribution of people with general diseases by age allowed us to establish a significant proportion of patients aged 40-49 years (30-J5%) and aged 50-59 years (60-65%). The number of patients under 40 years of age was 5-10%. The distribution of these persons by length of service showed that patients with work experience of up to 5 years, as a rule, were not identified, with experience of 6-10 years, 5-10% of patients were identified, with experience of 11-15 years - 25-30%, with experience of 16 -20 years - 30-40% of patients, with experience of more than 20 years - 25-30% of patients. When analyzing the results of periodic medical examinations and dynamics for the period from 1995 to 2000. no increase in morbidity rates was detected, the trend is stable. The presented data, the structure of pathology, and the professional affiliation of seafarers are quite consistent with the results of our hygienic assessment of working conditions on ships. Probably, working in hazardous production conditions contributes to the development of changes in health status.

As numerous studies in recent years have shown, many factors in the working environment, when exposed to the human body, can have a depressing effect on the nonspecific resistance of workers. As a result of a decrease in the body's resistance, these individuals experience an increase in the frequency of various diseases, a tendency to relapses and an atypical course of infectious processes. Facts established in recent years speak of the fundamental importance of the human system for preserving people’s health while adapting to various conditions of a changing production and external environment, [A.L. Sheparev, G.I. Bulgakov 1992-1996]. Taking into account the peculiarities of the working conditions of seafarers, it is very important to conduct research to identify among them “at-risk” groups with immunodeficiency states. This is due to the fact that timely and correct assessment of the nature and extent of immunological disorders is a fundamental point for carrying out immunocorrective therapy, pea-, bilitaciogashh and appropriate sanitary and hygienic measures. It is known that immunological indicators are very labile. This is determined by the fact that immune mechanisms in process of maintaining homeostasis in combination with neuroendocrine regulation are in a state of dynamic equilibrium. Therefore, having detected a deviation from the norm of one or another immunological indicator, it is necessary to make sure that this is not a manifestation of a homeostatic shift, but

a consequence of imbalances in the immune system. In connection with these circumstances, we carried out targeted questioning, interviewing and examination of seafarers using specially developed methods and cards for diagnosing immunological deficiency. It has been established that among the members of the energy department, the highest percentage (74%) is registered compared to specialists working in other departments, the proportion of people who should be classified as at risk for immunological deficiency. Moreover, more than 40% of the examined people in this group Deficiency of immunity is caused by the presence of combinations of immunological insufficiency. The second place in the ranking of occurrence of immunological disorders (60%) belongs to sailors working as electromechanics and radio operators. These specialists are characterized by more or less expressed secondary immunological insufficiency. A clear confirmation of unfavorable changes in the condition health of sailors working as part of deck crews, there is a significant number of people (54%) with primary immunological deficiency. An in-depth analysis revealed significant changes in the health of captains and mates. These changes are also in the nature of secondary immunological deficiency. Pronounced signs of immune deficiency are also observed among women employed on ships in auxiliary and maintenance operations (cleaners, orderlies). The analysis allowed us to establish that the most indicative manifestations of the immunological deficiency syndrome in sailors are diseases of colds and infectious ethnology in the form of recurrent respiratory diseases (repeating more than 3-4 times a year, acute respiratory viral infections, often recurring chronic bronchitis in combination with a history of - with chronic infection of ENT organs). Noteworthy is the increase in the number of cases of tonsillitis. A fairly common manifestation of immunodeficiency conditions is a pronounced allergic syndrome. In addition, bacterial infections of the skin and mucous membranes, therapeutically resistant stomatitis, and urogenital infections are characteristic. A significant proportion of ship specialists with an increased risk of developing immunodeficiency states complain of prolonged fever and subfibral disease of unknown ethnology. It should be especially noted that

Analysis of the obtained materials allows us to draw some conclusions about the existence of prenosological symptoms of activation and suppression of natural resistance factors. The predominance of the syndrome of suppression of natural immunity is typical for the first stages of adaptation to working conditions, and the syndrome of some activation of natural immunity is more clearly visible in sailors with 5-10 years of work experience. Occupational risk groups for the development of various forms of immune disorders include mechanics, mechanics, electromechanics, radio operators, sailors, navigators, and maintenance personnel. That is, practically all ship specialists, to one degree or another, belong to the risk group. And the more unfavorable working conditions seafarers are in, the higher the risk of developing the described changes in health. Consequently, ship specialists need in-depth medical examination, constant medical observation and a set of therapeutic and preventive measures aimed at increasing the natural and immune reactivity of their body. In addition, the obtained materials indicate the need to take into account and analyze immune deficiency as one of the criteria for assessing individual health during mass examinations of seafarers employed in hazardous working conditions. For this purpose, it is possible to use developed maps of immunological deficiency.

It is known that one of the reasons for changes in health status is the wide prevalence of so-called risk factors that predispose or directly lead to the development of pathology. A group of individual factors that have a direct and immediate connection with diseases and, for the most part, represent unfavorable changes that have already occurred in the body deserve special attention. This is excess, or less often underweight, high or low blood pressure, high levels of fatty substances and sugar in the blood. This also includes partial vitamin deficiency, deterioration in physical fitness, nonspecific resistance, etc. The group of risk factors also includes bad habits (addiction to drugs, smoking, drinking alcohol, overeating, violation of rest and sleep patterns, etc.). It has been established that the listed factors can be the cause of various chronic diseases, the so-called “diseases of civilization” (ischemic heart disease, hypertension, diabetes mellitus, chronic lesions

lungs, musculoskeletal system, malignant neoplasms, etc.). In addition, the identified factors are one of the reasons for the general deterioration of well-being, increased fatigue and decreased performance. The presented materials indicate the relevance of the problem of identifying and timely eliminating risk factors in working groups, as well as the need to carry out a set of measures to prevent them. We have conducted research to identify individual risk factors in teams of seafarers involved in the main production processes on sea vessels. Analysis and generalization of the received materials showed that the prevalence of such in groups is very wide. Thus, the number of smokers out of the total number of respondents was 61.4% of men and 21.2% of women. The number of people drinking alcohol was 85.3% of men and 50.3% of women. The vast majority of respondents drink alcohol quite moderately - less than once a month. However, 20.5% of men and 1.7% of women, according to a questionnaire survey, drink alcohol more than once a week. In the studied groups, the number of people who regularly engage in physical training and sports is very small. Thus, 10.3% of men and 8.6% of women are involved in sports sections. 17.7% of men and 7.4% of women regularly do morning exercises. 30.8% of men and 57.9% of women do not engage in any sports or physical training at all. The low level of physical activity in the studied groups appears to be one of the main reasons for the prevalence and such a serious health risk factor as excess body weight, which was assessed by the Broca index. At the same time, an increase in body weight compared to the norm by 10-20% was observed in 29.3% of women and 20.4% of men, an increase in weight by 21-30%, respectively, in 8.4% and 18.0% of those examined. In 10% of women and 4.0% of men, excess body weight was more than 30% of the normal level, which already corresponds to the presence of various degrees of obesity. Characteristically, “most often, excess of normal body weight was observed in older people, both men and women. At the same time, in the group of young sailors, a significant percentage of people with reduced body weight was noted. On average for the team, their number was 15.0% in the group of men, and 6.6% in the group of women. Risk factors indicating a general decrease in the body’s protective forces are:

increased vascular permeability (reduced vascular resistance). Examination of sailors using the “jar” test method according to A.I. Nesterov showed that the level of vascular resistance in sailor groups is not high enough. Thus, 17.0% of men and 28.6% of women had reduced values ​​of this indicator, including 12.0% of men and 18.0% of women in a pronounced form. In the specific climatographic conditions of the Far Eastern region, a significant risk factor is frequent vitamin deficiency in the body, especially pronounced in the spring-winter season. As studies have shown, the community level of hourly excretion of vitamin C in morning urine, both in the group of men and in the group of women, turned out to be quite high. At the same time, in both groups a significant percentage of people with a reduced excretion of vitamin C was identified (52.0% and 51%, respectively). In a large number of those examined, a pronounced decrease in excretion was found - less than 0.5 mg/h (in 29.0% and 32.0% of those examined, respectively), and in 2.7% of men and 2.3% of women a pronounced decrease was noted deterioration of this indicator (less than 0.3 mg/h), which indicates the presence of a deficiency of this vitamin in the body. One of the indicators of the general condition of the body can be a person’s sensitivity to weather changes, the so-called meteosensitivity. Increased sensitivity to weather changes most often indicates the presence of either obvious or hidden deviations from the norm in the body, and can be considered as an indirect risk factor. Analysis of survey data from seafarers showed that the number of people with a lack of weather sensitivity is small. The proportion of people reacting to weather changes is especially high in the group of women (78.0%). Among men there are slightly fewer of them - 57.0%. At the same time, the number of people who react sharply to weather changes is approximately the same (men - 11%, women - 9%). The data presented indicate the presence of a large number of people in seafarer groups with varying degrees and nature of changes in their health status. In general, this is confirmed by the data from the analysis of materials from the final reports of periodic medical examinations, and from the results of the analysis of immunoreactivity indicators. So, the presented materials indicate the presence in teams of seafarers there are a significant number of individuals who have individual risk factors and various forms of pre-morbid conditions, which is a favorable background for the development of pro-

professional and professionally caused morbidity. The specified contingent of workers should be the subject of attention of the medical service when carrying out a set of treatment and preventive measures at enterprises.

Thus, we have identified unfavorable changes in the health status of people working on sea vessels. It can be assumed that working in hazardous production conditions contributes to the development of changes in health status. Moreover, based on the hygienic assessment in general, the working conditions of seafarers were assessed as harmful, class 3 (2-4). As stated in Guideline 2.2.755 - 99, when working in hazardous working conditions, occupational diseases of varying severity may arise, there is a significant increase in chronic (work-related) pathology and high levels of morbidity with temporary disability. Therefore, an important point in preserving the health of seafarers should be considered the optimization of living conditions on ships, the development and strict implementation of hygienic measures and recommendations, etc. It is also important that in recent years there has been a sharp reduction to the complete absence of medical positions on ships. During the voyage period, seafarers do not have the opportunity to receive qualified medical care. As a result, there is no positive dynamics in indicators characterizing the health of seafarers. A significant number of people are identified with severe forms of occupational pathology and general somatic diseases. This means that one cannot expect an improvement in production performance indicators, an increase in the quality and productivity of labor.

The most important social problem in the Navy continues to be the level of industrial injuries. Injury rates for seafarers exceed similar data among industrial workers by 1.3 - 1.4 times. In this case, the injuries are particularly severe. This determines the need to continue the study of industrial injuries in the fleet, including the analysis of dashamikn, structure, and causes of injuries. Analysis of industrial injury indicators for the transport fleet of JSC Far Eastern Shipping Company for the period from 1993 to 1997. allowed us to establish the following. The main causes of industrial injuries are violations of labor and production discipline (on average 39.3%), negligence of the victim (27%), unsatisfactory

poor organization of work (22.5%), violations of the technological process (8.6%). Among other reasons, one should highlight the operation of faulty machines and equipment, non-use of personal protective equipment, imperfection of machines, mechanisms, and tools. In general, the share of causes associated with the so-called “human factor” accounts for more than two-thirds of all injuries that occur. Moreover, there is a pronounced tendency towards an increase in the proportion of injuries caused by the negligence of the victim. Having assessed industrial injuries by type of work, a predominance of deck and repair work was revealed. Their share accounted for approximately 30% of all injuries that occurred. In addition, loading operations, work of maintenance personnel, operation of machinery and equipment, watchkeeping and some others were important. When analyzing the age structure of workers who received work-related injuries, a predominance of people aged 18-30 and 31-40 years was revealed. On average, these age groups accounted for 34% and 39%, respectively. In third place, usually, were people 41-50 years old (approximately 16%), on Thursday - over 50 years old (11%). Thus, a decrease in the risk of occupational injuries is monitored with increasing age of workers, which is likely due to the acquisition of experience and work skills. This is also indicated by data obtained when assessing the work experience of persons injured while performing industrial activities. The proportion of victims with work experience of 5-10 years averaged 37%, with work experience of 10-15 years - 33%, and with work experience over 15 years - 19%. The share of people with minimal work experience was also small (10%). This may be due to the natural increased caution of people who have just arrived at work. The professional affiliation of the injured workers was different: sailors, mechanics, mechanics, maintenance personnel, turners, electricians, navigators, etc. At the same time, there was a significant predominance of the proportion of specialists who, due to the nature of their work, were in more unfavorable working conditions. These are sailors, mechanics and mechanics. The share of these professional groups averaged 40%, 33% and 30

% respectively. Probably, high levels of noise, vibration, significant air pollution, insufficient lighting levels and other factors characterizing the workplaces of these specialists contribute to faster development

fatigue, decreased quality, labor productivity and thereby determine the risk of injury. The above results of the analysis indicate that in order to prevent the occurrence of industrial injuries, it is necessary, first of all, to carry out organizational and administrative work (organization and coordination of the activities of all stakeholders in the field of labor protection). Ensuring labor safety, supervision and control over compliance with labor safety, improvement of the technological process, machines, equipment, timely repair and reconstruction of used equipment, etc. are important. Working with people is extremely important. We pointed out the significant role of the “human factor” in the structure of the causes that led to past injuries. By observing labor and production discipline, basic caution, and using personal protective equipment, it would be possible to prevent more than half of all injuries at work. Therefore, it is necessary to carry out work on training and providing information to workers about the actual conditions of their work. In our opinion, work to promote the prevention of industrial injuries will be very useful. This propaganda can be implemented in the following forms: educational films intended for use in educational institutions and centers for professional training and retraining of seafarers, and also for demonstration on board ships; safety posters on board ships; publications about the dangers of maritime professions and measures to prevent occupational injuries in periodicals intended for seafarers. It is apparently necessary to apply both moral and material incentives for certain achievements in the field of labor protection and the prevention of industrial injuries. All this will help reduce the level of industrial injuries, and therefore maintain the health and high performance of sailors.

So, the work we carried out showed that the living conditions on sea vessels are characterized by a complex of unfavorable physical, chemical, and psycho-emotional factors. The totality of the environmental conditions, the organization, the work and rest regime of crew members allow the working conditions of seafarers to be classified as harmful. This will give reason to consider these circumstances as the cause of a negative impact on the health of the crew, as well as the reason for the formation of work-related and occupational morbidity. So

Thus, the state of the working conditions of seafarers and their health continues to remain a very complex and multifaceted problem in the modern period. The foregoing justifies the need to organize a system of labor protection and health for seafarers. This system, in our opinion, should have a unified organizational, scientific, methodological basis, unite scientific and practical institutions, and be intersectoral and interdisciplinary in nature. The organization of the labor protection and health system we propose for seafarers is presented in Diagram 1. The main goal of the system is to create safe working conditions, ensure rights and guarantees; equal rights for workers to work in conditions that meet labor protection requirements, fulfillment of the responsibilities of the employer and employee in the field of safety labor to achieve the final result - preserving the life and health of workers, ensuring working conditions that eliminate or minimize the risk of an employee contracting an occupational disease or accident. Management of the system is entrusted to the ira management body, which is represented by the employer, its representatives at the appropriate levels, the labor protection service, the trade union, and medical institutions. The governing body makes the necessary management decisions, forms regulations on the organization of work, etc. The work of the system consists of the following components: organization and coordination of activities in the field of labor protection and health; planning activities in the field of occupational safety and health; ensuring labor safety; training and information support for occupational safety and health; assessment of working conditions and health; supervision and control of compliance with occupational safety and health requirements; ensuring timely medical care and rehabilitation of seafarers; stimulation in solving problems to improve conditions and labor protection and health.

Organization and coordination of activities in the field of occupational safety and health includes:

Organization of implementation of the fundamental principles of the state labor protection management system in the organization;

Interaction of all interested parties in resolving labor safety issues¡.cooperation of the employer and its representatives with employees, the labor safety committee, authorized (trusted) persons for labor protection of the collective

tiva, government bodies, supervision and control of the regional administration, etc.);

Development and implementation of a program of priority measures to improve working conditions and safety;

Compulsory social insurance of workers against industrial accidents and occupational diseases, investigation of such cases and provision of the necessary documents to the Social Insurance Fund for payments to victims.

An important condition for the functioning of the system, of course, is clear planning of its activities. “So, when drawing up estimates of expenses and income of an organization, it is necessary to plan financial support for measures to improve working conditions and labor protection. It is necessary to provide for the development and implementation of measures to improve and improve working conditions based on the results of certification of workplaces for working conditions, including the development and implementation of the activities included in the employment agreement. It is important to develop and timely implement an action plan to eliminate shortcomings discovered during ongoing inspections regarding labor protection issues. The same is true when investigating accidents and occupational diseases.

One of the fundamental elements ensuring the operation of the occupational safety and health system is ensuring occupational safety. Occupational safety must be ensured by the following measures:

Creation and provision of working conditions at each workplace that meet labor protection requirements;

Compliance with labor protection requirements of the vehicles, machines and other production equipment used, as well as materials, substances, products, technological processes;

Compliance with labor safety requirements during the design, construction, reconstruction, and repair of production facilities and vehicles;

Compliance with work and rest schedules for workers in accordance with the legislation of the Russian Federation and the Primorsky Territory;

Providing workers with means of individual and collective protection and their use at work;

OCCUPATIONAL SAFETY SCHEME FOR SAILORS ON SHIPS

Timely conduct of mandatory preliminary, periodic (including pre-trip), as well as extraordinary medical examinations of employees;

Providing sanitary, medical and preventive services for workers in accordance with labor protection requirements;

Ensuring the safety of workers during the operation of vehicles, buildings and structures, and the implementation of technological processes;

Taking measures to prevent emergency situations, protect the life and health of workers and passengers, people in the event of such situations, including providing assistance to the victims.

Training and information support for occupational safety and health are also important. It includes the following activities:

Passage by all management employees and specialists of the organization! training and testing knowledge of labor protection requirements for the position held;

Training in safe methods and techniques for performing work, conducting internships and briefings for employees to test their knowledge of the required labor protection; training of authorized (trusted) persons on labor protection;

Informing employees about labor conditions and safety in the workplace, about the existing risk of damage to health and the compensation and protective equipment they are entitled to;

Familiarization of employees with legislative and other regulations on labor protection. Occupational safety and health management system and other documents of the organization;

Professional retraining of workers in cases of liquidation of a workplace due to violation of labor protection requirements;

Carrying out preventive work to prevent injuries and occupational diseases using video equipment, computers and visual aids, literature, and the release of information messages;

Preparation of information, reports and other documents on labor protection and their provision to government authorities, supervision and control;

To assess the state of working conditions, which is an important element of the system’s operation, it is necessary:

Carrying out certification of workplaces according to working conditions with subsequent certification for compliance with labor protection requirements (obtaining a safety certificate);

Recording and quarterly analysis of violations of labor protection requirements that did not lead to accidents and occupational diseases;

Accounting and quarterly analysis of industrial accidents and occupational diseases;

Accounting and analysis of identified and corrected violations according to the instructions of workers on labor protection and the organization of public administration, supervision and control of labor protection;

Assessment of the level of conditions and labor protection, injuries and occupational diseases with the preparation of state statistical reporting according to established forms.

Supervision and control over compliance with occupational safety and health requirements includes:

Constant administrative control over the state of labor protection and health;

Public control over labor protection;

Departmental control;

Monitoring the state of working conditions and safety, as well as compliance with labor protection legislation by representatives of government bodies, supervision and control.

An extremely important part of the system’s work is to ensure timely and high-quality medical care and rehabilitation of seafarers. By this we mean multi-stage work:

Timely and competent professional guidance and professional selection;

Preliminary and periodic professional (psychophysiological and medical) selections;

Professional adaptation with mandatory medical, psychological and social correction;

Periodically conducted post-trip directed clinical and psychophysiological examinations in a hospital (if there is a disease, treatment in a hospital);

Post-trip rehabilitation treatment and rest in sanatoriums, recreation centers, rehabilitation centers, etc., with subsequent examination to assess the effectiveness of the rehabilitation carried out,

Rehabilitation of crew members on voyages, carried out by the ship's medical worker on the recommendation of a medical institution.

In conclusion, it must be emphasized that, of course, for the effective operation of the labor protection and health system for seafarers, stimulation in solving the problems of improving conditions and labor protection and health is of no small importance. For this purpose, it is advisable to apply moral and material encouragement to workers for achievements in the field of labor protection, as well as to apply liability for violation of labor protection requirements to employees who committed them, in accordance with the legislation of the Russian Federation (disciplinary, administrative, material, and in appropriate cases, criminal ).

The system of labor protection and health of seafarers that we have developed and described has been tested and implemented in the work of the Center of the State Epidemiological Agency for Transport (water and air) in the Far East region.

CONCLUSION

The dissertation work is a completed and independently completed scientific work, in which, on the basis of a comprehensive hygienic assessment of the working conditions of seafarers, new solutions are given to the current scientific and practical problem of preserving the health and high performance of ship specialists by organizing a labor protection system on sea “ships”, which will ensure working conditions that meet labor protection requirements.

Main conclusions

1. Working conditions for seafarers in accordance with the requirements of manual 2.2.75599 “Hygienic assessment criteria and classification of working conditions based on the harmfulness and danger of factors in the working environment, severity and stress of the labor process” are assessed as harmful as harmful (class 3) 2-4 degrees. The leading unfavorable production factors on ships are noise,

vibration, microclimate parameters, lack of lighting, tension and severity of labor.

2. The absence in R 2.2.755-99 of specific criteria characterizing the living conditions on ships (macroclimatic conditions of the navigation area, constant changes in time and climate zones, ship motion, psychophysiological characteristics of the functioning of closed groups, etc.) requires the development of an industry normative document that allows carry out a comprehensive hygienic assessment of all parameters that form the ship’s environment.

3. The structure of the identified pathology and professional performance of seafarers is consistent with the results of the hygienic assessment of working conditions on ships. The structure of occupational morbidity is dominated by changes in the auditory analyzer (sensorineural hearing loss, cochlear neuritis), as well as vegetative-sensory polyneuropathy. The vast majority of occupational diseases (more than 80%) are diagnosed in ship specialists working in the most unfavorable working conditions (mechanics, motorists), over the age of 50, with work experience of more than 20 years. The structure of general morbidity is also dominated by changes in the organ of hearing.

4. Immune disorders identified in seafarers justify the advisability of an in-depth medical examination, constant dispensary observation and a set of treatment and preventive measures aimed at increasing the natural immune reactivity of this contingent of workers. It is necessary to take into account and analyze immunological deficiency as one of the criteria for assessing health during mass examinations of seafarers. For this purpose, it is possible to use developed maps of immunological deficiency.

5. A significant number of seafarers have individual risk factors and diffuse forms of pre-disease conditions, which is a favorable background for the development of occupational and occupationally-related illnesses. This contingent of ship specialists should have. subject to the attention of the medical service when carrying out a complex of treatment and preventive measures.

5. The main causes of industrial injuries on sea vessels are violations of labor and production regulations, carelessness of the victim, unsatisfactory organization of work, violations of technical

logical process. Professionals at risk of occurrence of occupational injuries should be considered those working in more unfavorable working conditions (mechanics, mechanics, sailors). With increasing age and experience of seafarers, the risk of occupational injuries decreases.

8. In order to reduce the noise level in the power department on ships, it is necessary to install a sound-absorbing bulkhead separating the diesel generator area from the rest of the power department. This will reduce the noise level in the high-frequency range by 19 dB, which will significantly improve working conditions and increase productivity.

9. When sailing in northern latitudes, it is necessary to organize measures on sea vessels to prevent light starvation. This problem can be solved with the help of long-term ultraviolet irradiation installations, which are included in the artificial lighting system (in this case, people in the room are irradiated with a low-intensity flow during the entire time they are in it), as well as with the help of short-term installations (fotaria) .

1. Study of working conditions on the ships of the Sakhalin Shipping Company // Abstracts of reports of the XXXX scientific and technical conference of teachers and researchers of FEVIMU named after. adm. Nevelsky. - Vladivostok, 1986 - p. thirty.

2. Hygienic assessment of working conditions on certain types of ships and development of recommendations for their optimization // Man - Ocean: Materials of the All-Union Scientific Conference. - Vladivostok, 1988 - p. 73.

3. Study of the dynamics and structure of morbidity during a long-term voyage // Man - Ocean: Proceedings of the All-Union Scientific Conference. -Vladivostok, 19S8 - p. 317-318. (co-authors O.N. Tsys, V.S. Bulysheva, V.G. Marakhovskaya).

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INTRODUCTION

CHAPTER 1. LITERATURE REVIEW.

1.1. The ship environment and its impact on the health of seafarers.

1.2. Assessment of working and rest conditions for various professional groups of seafarers.

1.3. Performance of seafarers of various professional groups during a shift.

1.4- Health status of various professional groups of seafarers.

1.5. Injuries in the fleet and the connection with ship factors.

1.6 Measures to prevent illness and injury on sea vessels.

CHAPTER 2. SCOPE, MATERIALS AND METHODS OF RESEARCH.

CHAPTER 3 COMPREHENSIVE HYGIENIC ASSESSMENT OF WORKING CONDITIONS FOR SEAMEN (BASED ON THE EXAMPLE OF FAR EASTERN SHIPPING COMPANY OJSC VESSELS).

3.1* General characteristics of the vessels surveyed.

3.2. Hygienic assessment of physical and chemical factors that shape living conditions on sea vessels.

3.3, Hygienic assessment of the severity and intensity of work on naval vessels.

CHAPTER 4 - HEALTH STATE OF WORKERS ON MARINE VESSELS (BASED ON THE EXAMPLE OF VESSELS OF JSC "FAR EASTERN SHIPPING COMPANY"). 62

4.1. Analysis of seafarers’ health indicators based on the results of periodic medical examinations.

4.2- Analysis of occupational morbidity among seafarers.

4.3. The state of immunoreactivity of sailors.

4.4- Analysis of individual risk factors for seafarers.

CHAPTER 5. ANALYSIS OF OCCUPATIONAL INJURIES ON MARINE VESSELS.76

CHAPTER 6. ORGANIZATION OCCUPATIONAL SAFETY SYSTEM AND

SAILORS' HEALTH.79

DISCUSSION OF RESULTS.87

Introduction 2000, dissertation on human life safety, Konovalov, Yuri Vasilievich

Relevance of the problem. The modern development of the fleet is inextricably linked with solving the problem of preserving and strengthening the health of sailors, improving the conditions of their work, life, and recreation. The most important condition for maintaining the health of seafarers is to ensure an optimal living environment on board the ship. In this case, the ship must be considered as an artificial ecologically closed system that provides the crew with a long active existence.

The human body during navigation is simultaneously affected by a complex of interrelated environmental factors of different levels and nature (climatic conditions of the navigation area, microclimate of ship premises, noise, vibration, electrostatic radiation, electromagnetic radiation, harmful substances in the air, microflora of premises, psychophysiological factors and etc.). The number of ship environmental factors can reach several dozen. A person ultimately reacts to the environment as a whole. Therefore, the criterion reflecting the influence of the ship environment on the human body is the level of the worker’s functional state and his health [L.M. Matsevich, 1978, 1999; E.F. Pisarenko, V.N. Timofeev, 1997].

Currently, there is an unsatisfactory state of working conditions and a high level of occupational morbidity among maritime transport workers. The intensification of labor on a voyage is increasing. There is poor quality of preliminary and periodic medical examinations, a reduction in medical positions on ships, leading to a decrease in the quality of medical care or its complete absence. Vessels of outdated designs, with expired service life, are used. These circumstances lead to deterioration of the living environment on ships and pose a threat to the health of workers. At the same time, research works devoted to comprehensive hygienic assessment

5 working conditions and the study of the health status of seafarers in modern conditions are few, and the information available in them is often contradictory. The foregoing substantiates the relevance of conducting scientific research devoted to further study of the complex of factors that shape living conditions on ships.

Goal of the work. To develop a modern system of science-based measures to prevent the adverse effects of ship environmental factors on the human body to preserve the health and high performance of seafarers.

Research objectives:

Conduct a hygienic assessment of the physical and chemical factors that shape the living conditions on sea vessels, assess the severity and intensity of work on sea vessels;

Carry out a comprehensive assessment of the health status of seafarers;

Conduct an analysis of industrial injuries on naval vessels;

To provide a scientific basis for the system of preventive measures and recommendations for occupational safety and health of workers on naval vessels in the modern period.

Research methods included hygienic, psychophysiological, sociological (questionnaires and interviews), sanitary-statistical using a computer and analytical.

Provisions for defense:

The leading unfavorable production factors on ships should be considered noise, vibration, microclimate parameters, lack of lighting, tension and severity of labor;

Working in hazardous production conditions contributes to the development of changes in the health status of seafarers, determines the structure of production-related and occupational morbidity, and increases the risk of occupational injuries; - the state of working conditions and health of ship specialists justifies the need to organize a system of labor protection and health of seafarers, the main goal of which is to create safe working conditions that eliminate or minimize the risk of an employee receiving an occupational disease or accident, preserving the life and health of ship specialists.

Scientific novelty of the work. For the first time in the conditions of the Far Eastern region, a comprehensive sanitary and hygienic assessment of working conditions, an analysis of the health status and occupational injuries of specialists working on sea vessels was carried out. The leading harmful production factors are identified, the features of occupational and production-related morbidity are determined. For the first time, an assessment of the natural resistance of the sailors’ body, as well as an analysis of individual risk factors, was given. On this basis, a system of occupational safety and health for seafarers has been justified and developed.

The practical value of the work is that, based on a comprehensive assessment of working conditions and the health status of seafarers, a system of labor protection and health of persons working on sea vessels has been proposed, which will ensure working conditions that meet safety requirements, which will help preserve the life and health of sea workers transport.

Implementation of work results.

The proposed conclusions and recommendations are used by the Department of Labor, Employment and Demographic Policy of the Primorsky Territory Administration; administration of the Far Eastern Shipping Company company; TsGSEN in transport (water and air) in the Far Eastern region to formulate a policy in the field of labor protection of workers

7 maritime transport, for planning and implementing measures to improve the working conditions and safety of seafarers, medical care and rehabilitation of ship specialists. Fragments of the dissertation are used when giving lectures and conducting practical classes at the Department of Occupational Medicine of VSMU.

Approbation of work. The main provisions of the dissertation work were reported and discussed at the XXXX scientific and technical conference of teachers and researchers of the Far Eastern VIMU named after. adm. Nevelskoy (Vladivostok, 1986); at the All-Union Conference "Ocean Man" (Vladivostok, 1988); at the scientific conference "Hygiene of long voyages" (Leningrad, 1989); XI International Symposium on Marine Medicine (Poland, Gdynia, 1989); anniversary scientific conference "Medical and social problems of public health in the Far East" (Vladivostok, 1991); thematic scientific and practical conference "Current issues of hygiene and ecology of transport" (Ilyichevsk, 1992); scientific and technical conference "Primorsky Dawns" (Vladivostok, 1998); scientific and technical conference "Vologda readings. Ecology and life safety" (Vladivostok, 1999); at the scientific and practical conference “Primorskie Dawns - 99” (Vladivostok, 1999); at the Far Eastern regional scientific and practical conference “Modern aspects and problems of labor protection, life safety in fishery organizations of the Far Eastern basin-99” (Vladivostok, 1999); at the conference “Ecology, life safety, labor protection and sustainable development of the Far Eastern territories” (Vladivostok, 2000); at regional meetings with government experts on working conditions in municipalities of the Primorsky Territory 1992-2000; at the meetings of the Interdepartmental Commission on Labor Safety in the Primorsky Territory 1995-2000.

Conclusion dissertation on the topic "Working conditions and health status of seafarers"

1. Working conditions for seafarers in accordance with the requirements of manual 2.2.755-99 “Hygienic assessment criteria and classification of working conditions according to indicators of harmfulness and danger of factors in the working environment, severity and intensity of the labor process” are assessed as harmful as harmful (class 3) 2-4 degrees. The leading unfavorable production factors on ships are noise, vibration, microclimate parameters, lack of lighting, tension and severity of labor.

2. The absence in R 2.2.755-99 of specific criteria characterizing the living conditions on ships (macroclimatic conditions of the navigation area, constant changes in time and climate zones, ship motion, psychophysiological features of the functioning of closed groups, etc.) requires the development of an industry normative document that allows carry out a comprehensive hygienic assessment of all parameters that form the ship’s environment.

3. The structure of the identified pathology and the professional affiliation of the seafarers is consistent with the results of the hygienic assessment of working conditions on ships. The structure of occupational morbidity is dominated by changes in the auditory analyzer (sensorineural hearing loss, cochlear neuritis), as well as vegetative-sensory polyneuropathy. The vast majority of occupational diseases (more than 80%) are diagnosed in ship specialists working in the most unfavorable working conditions (mechanics, motorists), over the age of 50, with work experience of more than 20 years. The structure of general morbidity is also dominated by changes in the organ of hearing.

4. Immune disorders identified in seafarers justify the advisability of in-depth medical examination, constant

109dispensary observation and carrying out a complex of treatment and preventive measures aimed at increasing the natural immune reactivity of this contingent of workers. It is necessary to take into account and analyze immunological deficiency as one of the criteria for assessing health during mass examinations of seafarers. For this purpose, it is possible to use developed maps of immunological deficiency.

5. A significant number of seafarers have individual risk factors and various forms of pre-morbid conditions, which is a favorable background for the development of occupational and work-related morbidity. This contingent of ship specialists should be the subject of attention of the medical service when carrying out a set of treatment and preventive measures.

6. The main causes of industrial injuries on sea vessels are violations of labor and production discipline, carelessness of the victim, unsatisfactory organization of work, and violations of the technological process. Occupational risk groups for occupational injuries should be considered those working in more unfavorable working conditions (mechanics, mechanics, sailors). With increasing age and experience of seafarers, the risk of occupational injuries decreases.

7. It is necessary to organize a system of occupational safety and health for seafarers, which has a unified organizational, scientific, methodological basis, uniting scientific and practical institutions, of an intersectoral and interdisciplinary nature.

8. In order to reduce the noise level in the power department on ships, it is necessary to install a sound-absorbing bulkhead separating the diesel generator area from the rest of the power department. This will reduce the noise level in the high-frequency range by 19 dB, which

110will have a significant impact on improving working conditions and increasing productivity.

9. When sailing in northern latitudes, it is necessary to organize measures on sea vessels to prevent light starvation. This problem can be solved with the help of long-term ultraviolet irradiation installations, which are included in the artificial lighting system (in this case, people in the room are irradiated with a low-intensity flow during the entire time they are in it), as well as with the help of short-term installations (fotaria).

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Vibration disease is an occupational disease that occurs as a result of prolonged exposure to a physical phenomenon such as vibration. It is based on pathophysiological processes in the peripheral and central nervous system. Unfortunately, vibration today often accompanies the production process, despite new technologies. Mechanical and shipbuilding, aircraft production, metallurgy, construction and mining industries, road repair work are inconceivable without the use of impact or rotary tools. Therefore, vibration disease is quite common in clinical practice.

But, nevertheless, you cannot let the disease take its course. It is very important to know the symptoms of the disease, especially if you or your loved ones are at risk. Treatment will be prescribed by a doctor, and prevention, which we will discuss in this article, is available to everyone.

What is vibration? The effect of vibration on the body.

Vibration is a mechanical oscillatory movement with a certain frequency. Vibration with a frequency of 16-200 Hz is considered the most dangerous. Based on the type of contact with the worker’s body, vibration can be:

• local: when the place of contact of vibration with the body is the hands. Vibration is transmitted through the hands to the entire body. Typical for those professions where work involves holding a tool in the hands (riveters, sharpeners, sanders, choppers, working on machines, etc.);
• general: when vibrations are transmitted to the body through the support (the place where the worker stands or sits). For example, drivers of heavy vehicles, concrete molders.

The clinical picture depends on what type of vibration the work involves, as well as the presence of other harmful production factors, such as noise (often accompanied by vibration), hypothermia, and forced body position. In addition, quite often in production there is exposure to both local and general vibration.

Vibration constantly irritates peripheral receptors located on the extremities (arms or legs, depending on the type of vibration). Nerve impulses are transmitted to higher structures of the nervous system - the reticular formation, the sympathetic division of the nervous system. With prolonged exposure to vibration, overstimulation of these structures occurs, ultimately leading to disruption of the regulation of vascular tone in the central nervous system. Vascular spasm develops (initially in the areas of vibration, and later generalized throughout the body). This leads to disruption of microcirculation and blood supply, tissue nutrition, increased blood pressure, which is accompanied by changes in the nervous system, cardiovascular system, and musculoskeletal system. Subsequently, dystrophic changes develop in organs and tissues. Even if the provoking factor is eliminated (change of job), a complete cure is not always possible, especially if the process has generalized.

In order for the diagnosis of vibration disease to be justified, sufficient experience working with vibration (documented) is necessary. Usually the first “bells” appear after 3 years, but for a reliable diagnosis, doctors require at least 5 years of experience.

Symptoms

There are three types of vibration disease:

• from exposure to local vibration;
• from the effects of general vibration;
• from exposure to both types of vibration.

According to the severity of the pathological process, it is customary to distinguish 4 stages:

• initial, with minimal manifestations of the disease, which are functional and reversible;
• moderate;
• expressed;
• generalized: has been rare lately, as people change their profession and stop contact with vibration.

In addition, the clinical picture includes the following syndromes (which can be observed to varying degrees in one or another type of vibration disease):

• angiospastic;
• angiodystonic;
• polyneuropathic;
• polyradicular;
• asthenic;
• vegetative-vestibular;
• diencephalic;
• nonspecific changes in internal organs (for example, intestinal dyskinesia).

Vibration disease from local vibration

This form of the disease occurs among people who work with hand-powered tools. Patients complain of aching and nagging pain in the hands, mainly at night and during rest. The pain may be accompanied by the appearance of paresthesia: a feeling of crawling, tingling, numbness. Chilliness of the extremities is characteristic. The pain stops when you resume working with the vibrating tool after 10-15 minutes. Periodically there are attacks of whitening of the fingers. There is a characteristic feature: hewers (cutters) have white fingers on their left hand, and sanders, polishers and similar workers have white fingers on both. Attacks of whitening can occur either independently or when exposed to cold (washing hands with cold water, general hypothermia).

Over time, the fingers become swollen and take on the appearance of “drumsticks” - with thickenings at the ends; joints are deformed, the range of movements in them decreases. Trophic disorders are manifested by hyperkeratosis, the pattern on the distal phalanges is smoothed out, the nails thicken and become cloudy. Multiple cracks on the palms are often observed. When the process is far advanced, trophic disorders also affect deeper tissues: subcutaneous fat, muscles and tendons, which manifests itself in the form of myositis, tendonitis, and tendomyositis. X-rays reveal foci of osteoporosis and cyst-like formations in the bones. Degenerative-dystrophic changes are found in the spine (mainly in the intervertebral discs) and in the joints.

There is a feeling of coldness in the extremities to the touch; dry skin of the hands or increased sweating are possible.

All these are manifestations of angiospastic and angiodystonic syndromes.

Polyneuropathic syndrome consists of the development of sensitivity disorders. Suffering mainly from pain, temperature and vibration sensitivity. Initially, hyperesthesia (increased sensitivity to irritants) is possible, which over time is replaced by hypoesthesia (accordingly, a decrease in this sensitivity). Gradually, the higher located areas are also involved in the process: from the hands, changes move to the forearms (on the legs - from the feet to the shins), like “gloves” and “socks”. The pronounced stage of vibration disease from local vibration is accompanied by loss of sensitivity according to the segmental type. Rarely, motor disorders are observed in the form of hypotrophy (atrophy) of the small muscles of the hand: thenar, hypothenar, interosseous muscles.

When the body is exposed to noise, in addition to vibration, cochlear neuritis develops, i.e. hearing loss, which can be detected during audiometry.

Vibration disease from exposure to general vibration

One of the manifestations of vibration disease is polyneuropathy of the lower extremities.

This variety is found among machine plant workers and truck drivers. As a rule, the onset of the disease is gradual. Gradually, a wide variety of complaints appear: headache, increased fatigue, sleep disturbance, dizziness, nausea, irritability, memory impairment, general malaise, increased sweating, which, of course, are nonspecific. Vegetative-vestibular syndrome comes to the fore. Along with this, signs of angiodystonic syndrome and sensory polyneuropathy in the lower extremities appear.

On examination, microsymptoms are revealed: tremor of the eyelids, fingers of outstretched arms, anisoreflexia (unequal reflexes on the right and left), instability while standing with eyes closed and arms outstretched, in the so-called Romberg position. Pain in the extremities, coldness and chilliness of the legs appear, which is associated with vascular spasm. Gradually, changes in biochemical processes in tissues, inflammation with compression of the nerve roots in the spinal cord are added to the manifestations of systemic damage to peripheral nerves. Muscle atrophy develops. In some cases, there is a disorder of the functions of internal organs, for example, a violation of the secretion of the glands of the digestive system. Pathological changes are also noticeable in the cardiovascular system: blood pressure rises, heart rhythm disturbances appear.

With prolonged exposure to general vibration on the body, vascular spasm becomes generalized, that is, it affects the vessels of the entire body. Patients complain of coronary-type pain in the heart area, signs of chronic cerebrovascular accident appear (usually dyscirculatory encephalopathy, but there may also be diencephalic manifestations). In women, due to impaired blood flow in the pelvic organs, menstrual irregularities occur, in men - problems with potency.

Vibration disease from exposure to both types of vibration

Clinical manifestations are the same as for the conditions described above. Only usually the disease manifests itself a little earlier and progresses a little faster, since the harmful effects of vibration on the body seem to double.

Diagnostics

To establish a diagnosis, professional history and sanitary and hygienic characteristics of working conditions play an important role, which should indicate the vibration indicators with which the employee comes into contact. It is mandatory to conduct additional research methods: skin thermometry, capillaroscopy, algesimetry (study of pain sensitivity), determination of vibration sensitivity. Capillaroscopy reveals spastic-atony of blood vessels, less often - only spasm or atony.

Vibration disease is a complex of pathological changes that develop in the body as a result of prolonged exposure to vibration.

Vibration disease occurs from the action of vibration (from the Latin vibratio - “trembling, oscillation”) or frequently repeated mechanical influences. Usually occurs as an occupational disease.

The pathology was first described in 1911 by the Italian doctor G. Loriga.

Synonyms: vibration syndrome, vibration angioneurosis, pseudo-Raynaud's disease, white finger syndrome.

External manifestations of vibration disease

Causes and risk factors

The reasons causing vibration may be:

• local - the traumatic effect is on a certain part of the body, for example, on the hands when working with pneumatic tools, hand rammers;
• general - the impact is on the entire surface of the body (in transport, etc.);
• combined - combining local and general effects of vibration.

The mechanism of development of the disease is based on the reflex-humoral reaction of the body in response to vibration. This reaction involves receptors in the skin, cardiovascular, muscular and skeletal systems. Vibration causes microtrauma to the peripheral nervous and circulatory systems and is manifested by disturbances in blood circulation and trophism (nutrition) of the tissue.

The effect of vibration on the body depends on the strength, frequency and duration of exposure. One of the important parameters is the oscillation frequency, which is measured in hertz (Hz). There is evidence of the following reactions of the body to a certain vibration frequency:

• vibrations up to 15 Hz cause a reaction of the vestibular apparatus, displacement of organs;
• vibrations of 15–25 Hz lead to changes in the tissues of bones and joints, and can manifest themselves as sensations of individual tremors (pallesthesia);
• Oscillations of 50–250 Hz cause reactions from the cardiovascular and nervous systems.

Higher frequencies refer to ultrasound, which entails the conversion of mechanical energy into thermal energy.

The acute form of vibration disease is extremely rare - in cases of intense vibration or explosion; This form of the disease is called vibration trauma and is considered as a separate pathology.

The most dangerous range for humans is from 15 to 250 Hz.

In addition, risk factors include:

• individual sensitivity of the body;
• incorrect posture during work, tense or forced body position;
• overwork, constant background noise, hypothermia and other factors that reduce the body’s resistance to stress.

Forms of the disease

The development of vibration disease takes time: as a rule, we are talking about years and even decades spent in conditions of regularly exposed vibration, so the pathology is characterized by a chronic course. The acute form is extremely rare - in cases of intense vibration or explosion; This form of the disease is called vibration trauma and is considered as a separate pathology.

Stages of the disease

The stage of vibration disease is considered taking into account the degree, area and time of exposure to vibration. In total, there are 4 stages of vibration disease:

1. Initial.
2. Moderately expressed.
3. Expressed.
4. Generalized.

Symptoms

The disease in the initial (I) stage has the following manifestations:

• malaise;
• low body temperature;
• decreased sensitivity (slight numbness) and minor pain in the fingers and muscles of the shoulder girdle;
• rare finger spasms.

At this stage, all changes are reversible.

At stage II, the body’s compensatory mechanisms are exhausted. Its symptoms:

• persistent decrease in body temperature;
• decreased sensitivity of fingers;
• spasms in the fingers of the upper and lower extremities;
• weakness and pain in the limbs - aching, aching, pulling, which are sometimes accompanied by “goosebumps” and bother you at night or during rest;
• increased fatigue;
• anxiety, nervousness.

A long course of vibration disease causes deep and varied disorders of the nervous, cardiovascular, digestive and endocrine systems.

Stage III of the disease is rare, the changes are persistent and difficult to treat. Its symptoms:

• paroxysmal spasms of the hand and foot (one or both), calf muscles;
• stiffness of fingers;
• upon cooling (and sometimes spontaneously), sharp whitening, and then an equally sharp blue discoloration of one or both hands;
• thinning and deformation of the nail plates of the fingers;
• decreased sensitivity of individual muscle groups of the shoulder girdle, indicating damage to individual centers in the spinal cord;
• disorders of the endocrine system.

At stage IV, violations take on a general, generalized nature:

• persistent circulatory disorders, causing disorders of tissue trophism up to the formation of foci of necrosis (usually localized on the extremities);
• cerebrovascular accident (manifested by decreased memory and concentration, impaired coordination of movements, etc.);
• pathological changes in the spine (osteochondrosis and other pathologies).

In addition, at stages III and IV of vibration disease the following are noted:

• general poor physical and psycho-emotional well-being;
• persistent headaches;
• sleep disorders;
• nausea and motion sickness when traveling in transport;
• compressive pain in the heart and stomach;
• gastrointestinal disorders;
• endocrine disorders.

Diagnostics

The diagnosis is assumed on the basis of a characteristic clinical picture and anamnesis data, and the connection between complaints about well-being and working conditions is revealed.

Vibration disease occurs from the action of vibration (from the Latin vibratio - “trembling, oscillation”) or frequently repeated mechanical influences. Usually occurs as an occupational disease.

They also resort to a number of laboratory and instrumental methods. The following are required:

• general and biochemical blood test, general urine test;
• electrocardiography;
• X-ray of the chest organs, hands, feet, spine.

To confirm the diagnosis, special methods are used:

• cold test – assesses the state of the sympathetic nervous system;
• Pahl's test - the blood filling of the same-named vessels on different limbs is determined;
• white spot test - the time of occurrence of vascular spasm in the hands is assessed;
• test for reactive hyperemia - to restore vascular tone after compression;
• algesimetry – pain sensitivity of the forearm, lower leg, fingers and toes is established;
• pallesthesiometry – vibration sensitivity threshold is determined;
• skin thermometry – the severity of vascular changes in the hands is determined;
• capillaroscopy – changes are detected in the capillaries of the nail bed on the fourth finger of the right hand and the first finger;
• hand dynamometry - the strength of flexion of the fingers is determined;
• thermoesthesiometry – the ability to distinguish between temperature differences of up to 5 °C is established;
• hemodynamic test (Bogolepov test) - for blood filling of the hands when the position of body parts in space changes;
• Doppler ultrasound (USDG) – studies the arterial and venous blood flow of the extremities;
• rheovasography – pulse filling of the vessels of the hands and forearm with blood is determined.

There are other ways to study the effects of vibration sickness.

Treatment

The main condition for effective treatment is the elimination of vibration load. Therapeutic measures for vibration disease are aimed at restoring blood circulation and metabolic processes in the muscular and nervous system. For this purpose the following are used:

• drug therapy (vitamins, vasodilators, agents that improve tissue trophism and microcirculation);
• physiotherapy (electrophoresis, galvanic and mineral baths, UHF and UV irradiation, massage, acupuncture, mud applications);
• physiotherapy;
• spa treatment.

Possible complications and consequences

A long course of vibration disease causes deep and varied disorders of the nervous, cardiovascular, digestive and endocrine systems. The extreme degree of manifestation of the disease is profound disability.

It takes time for vibration disease to develop: as a rule, we are talking about years and even decades spent in conditions of regularly exposed vibration.

Forecast

With timely diagnosis, treatment and compliance with medical recommendations, the prognosis is favorable.

Prevention

To prevent vibration disease, people whose work activities involve constant exposure to vibration need to:

• comply with labor protection measures;
• during work, use tools, equipment, special work clothes with devices that dampen vibration;
• undergo preventive medical examinations in a timely manner;
• after each shift, perform self-massage of the limbs;
• eat well, make sure that your diet contains sufficient quantities of foods containing vitamins B1 (bran, meat, liver, brewer's yeast, eggs, seeds) and C (rose hips, black currants, citrus fruits, bell peppers, tomatoes, onions, leafy greens).

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