Vibration disease (2) - Abstract. Vibration disease: symptoms, treatment and prevention General information about occupational diseases of seafarers

INTRODUCTION
1. Vibration
Types of vibrations Impact of vibration on the human body
2. Vibration disease
2.1. Symptoms 2.2. Vibration reduction methods
3. Vibration regulation
CONCLUSION
LIST OF REFERENCES USED

INTRODUCTION

IN modern world We are surrounded by a huge number of mechanisms, more and more products of technical progress are appearing. All this cannot but affect the people who are directly related to them. Occupational diseases arise due to exposure to physical factors in the working environment such as vibration, noise, electromagnetic waves of the radio frequency and optical range. One of these diseases is vibration disease.

Vibration disease is an occupational disease that develops under the influence of vibration on the human body, i.e. mechanical vibration of material points or bodies. This disease usually occurs in drillers, choppers, riveters, molders, sharpeners, grinders and workers in other specialties associated with the use of rotating pneumatic and electric tools (vibrators), jackhammers, etc. It was described by the Italian doctor G. Loriga in 1911, although the first attempts describe it were made back in the 19th century. Russian doctors A. N. Nikitin, F. F. Erisman and others.

Vibration occurs in a wide variety of technical devices due to imperfections in their design, improper operation, external conditions (for example, the topography of the road surface for cars), as well as specially generated vibration.

Goal of the work expand on the topic “Vibration disease. Vibration normalization” using the assigned tasks.

Job objectives:

define vibration, describe the types of vibration and their effect on the human body;

characterize vibration disease, describe its symptoms and methods of reducing vibration;

define vibration regulation;

give a formula for calculating vibration normalization.

From the sources studied, it can be noted that the topic of vibration disease is not fully covered. Textbooks provide a clear description of vibration, its occurrence and methods for reducing it. The vibration disease itself is poorly described.

Vibration

Vibration are called mechanical vibrations experienced by some body. Vibration is caused by unbalanced forces. 1 Vibrations are used in medicine and technology, but prolonged exposure to vibration on humans is dangerous.

1.1. Types of vibrations

Depending on the method of transmission of vibrations to a person, general and local (local) vibrations are distinguished.

General vibration causes shaking of the entire body. It is divided into five categories.

general vibration category 1 - transport vibration affecting a person in the workplace of vehicles moving along the terrain, roads, etc. Example: tractors, trucks, scooters, motorcycles, mopeds;

general vibration category 2 - transport and technological vibration affecting a person at the workplace of machines moving on specially prepared surfaces production premises etc. Example: cranes, floor-mounted production vehicles;

general vibration category 3 - technological vibration affecting people at workplaces of stationary machines or transmitted to workplaces that do not have vibration sources. Example: machine tools, foundry machines.

general vibration in residential premises and public buildings from external sources. Example: vibration from a passing tram.

general vibration in residential premises and public buildings from internal sources. Example: elevators, refrigerators.

General vibration predominates, for example, when drivers work on lifting and transport and loading and unloading machines.

Local (local) vibration affects individual parts of the body. It comes in two types.

local vibration transmitted to a person from hand-held mechanized (with engines) tools;

local vibration transmitted to a person from a hand-held non-mechanized tool.

Local vibration of low intensity can have a beneficial effect on the human body, restore trophic changes, improve the functional state of the central nervous system, accelerate wound healing, etc. 2

Sometimes a person may be simultaneously exposed to general and local vibration (combined vibration). Vibration disrupts the activity of the cardiovascular and nervous systems, causing vibration disease. A mixed impact with a predominance of local vibration occurs during the operation of a number of hand-held machines, when the oscillatory movements of the tool and machine are transmitted to the body not only through the upper, but also through the lower limbs, chest, back, which depends on the working posture and design of the tool. For example, when working with a pneumatic hammer to fasten parts of wooden containers.

According to the direction of action, vibration is divided into vertical, propagating along the axis X, perpendicular to the supporting surface; horizontal, spreading along the axis at from back to chest; horizontal, spreading along the axis z from right shoulder to left.

According to the time characteristic, they distinguish: constant vibration, for which the controlled parameter during the observation period changes no more than 2 times (6 dB); not constant vibration, varying according to controlled parameters by more than 2 times. 3

1.2. Impact of vibration on the human body

The human body is considered as a combination of masses with elastic elements that have natural frequencies, which for the shoulder girdle, hips and head relative to the supporting surface (standing position) are 4-6 Hz, for the head relative to the shoulders (sitting position) - 25-30 Hz For most internal organs, natural frequencies lie in the range of 6-9 Hz. General vibration with a frequency of less than 0.7 Hz, defined as pitching, although unpleasant, does not lead to vibration disease. The consequence of such vibration is seasickness, caused by disruption of the normal activity of the vestibular apparatus due to resonance phenomena.

When the oscillation frequency of workplaces is close to the natural frequencies of internal organs, mechanical damage or even ruptures are possible. Systematic exposure to general vibrations, characterized by a high level of vibration velocity, leads to vibration disease, which is characterized by disturbances in the physiological functions of the body associated with damage to the central nervous system. These disorders cause headaches, dizziness, sleep disturbances, decreased performance, and deterioration of cardiac activity.

The characteristics of the impact of vibration are determined by the frequency spectrum and the location within its limits of the maximum levels of vibration energy.

With an increase in the intensity of vibrations and the duration of their exposure, changes occur, leading in some cases to the development of occupational pathology of vibration disease.

Manual machines whose vibration has maximum energy levels in low frequencies(up to 35 Hz), cause vibration pathology with primary damage to the neuromuscular and musculoskeletal system. When working with hand-held machines, the vibration of which has a maximum energy level in the high-frequency region of the spectrum (above 125 Hz), vascular disorders occur with a tendency to spasm peripheral vessels. When exposed to low-frequency vibration, the disease occurs after 8-10 years (molders, drillers), when exposed to high-frequency vibration - after 5 years or less (grinders, straighteners). 4

Vibration disease

Vibration pathology ranks second (after dust) among occupational diseases. Considering health problems caused by vibration exposure, it should be noted that the frequency of diseases is determined by the dose, and the characteristics of clinical manifestations are formed under the influence of the vibration spectrum. Three types of vibration pathology are distinguished from the effects of general, local and jerky vibrations.

When general vibration affects the body, first of all the nervous system and analyzers: vestibular, visual, tactile. Vibration is a specific stimulus for the vestibular analyzer, with linear accelerations for the oolitic apparatus located in the vestibular sacs, and angular accelerations for the semicircular canals of the inner ear. General low-frequency vibration affects metabolic processes, manifested in changes in carbohydrate, protein, enzyme, vitamin and cholesterol metabolism, and biochemical blood parameters. Under the influence of general vibrations, there is a decrease in pain, tactile and vibration sensitivity. Jerky vibration is especially dangerous, causing microtrauma of various tissues with subsequent reactive changes.

Vibration disease from the effects of shocks and general vibration is observed among transport drivers and operators of transport-technological machines and units, at factories of reinforced concrete products.

2.1. Symptoms

Workers with vibration diseases have dizziness, loss of coordination of movements, symptoms of motion sickness, and vestibular-vegetative instability. Violation of visual function is manifested in the narrowing and loss of certain areas of the visual field, sometimes up to 40%, subjectively - darkening in the eyes.

The clinical symptoms of vibration disease consist of peripheral neurovascular disorders and trophic disorders in the muscles and bones of the limbs and shoulder girdle. The disease develops after 3-15 years of working in vibration conditions. The main clinical syndromes are peripheral angiodystonic syndrome, acrospasm syndrome (Raynaud's syndrome) and sensory (vegetative-sensory) polyneuropathy of the extremities (arms or legs depending on exposure to local or general vibration). Characteristic complaints are chilliness, paresthesia of the limbs, changes in the color of the skin of the fingers when cooling (they turn white or become bluish), decreased strength in the hands, cramps in the hands, feet and calf muscles. Hypothermia, cyanosis and hyperhidrosis of the extremities, trophic changes in the skin (hyperkeratosis) and nails (thickening, deformation or thinning of the nail plates), swelling or pastiness of the hands with stiffness of the fingers are observed. As vibration disease progresses, the frequency and duration of vasospasms increase. When exposed to general vibration, there is a decrease in the pulsation of the arteries on the back of the feet and legs. A characteristic symptom is an increase in the threshold of vibration, pain, temperature, and less often tactile sensitivity. Sensory impairment is polyneuritic in nature. As the disease progresses, segmental hypalgesia and dystrophic disorders of the musculoskeletal system are revealed. Along with pain, thickening, heaviness, and focal crepitus are detected in the muscles of the limbs and shoulder girdle. With long-term (15 years or more) exposure to general vibration (most often among tractor drivers, bulldozer and excavator operators), dystrophic changes in the spine (osteochondrosis, deforming osteoarthritis of the lumbosacral, less often of the cervicothoracic region) with secondary radicular syndrome often occur.

Peripheral neurovascular and trophic disorders are often combined with functional changes in the central nervous system, which manifest themselves in the form of cerebral angio-dystonic or neurasthenic syndrome. These disorders are most pronounced in vibration disease, caused by exposure to general vibration. At the same time, patients complain of fatigue, dizziness, headaches, intolerance to travel in transport,

Conventionally, there are three degrees of vibration disease:

I degree - initial manifestations;

I degree - moderately expressed manifestations;

III degree - pronounced manifestations.

Stage I vibration disease is asymptomatic. Patients complain of mild pain, chilliness, and paresthesia of the hands. There are mild sensitivity disorders in the terminal phalanges (hyper- or hypalgesia), a mild decrease in vibration sensitivity, a slow recovery of the skin temperature of the fingers after cooling, and a change in capillary tone. Angiospasms are rare.

With vibration disease of degree II, the intensity and frequency of manifestations of the disease increase. Sensitivity disorders, especially vibration sensitivity, become more pronounced.

Vibration disease of the third degree is rare and is characterized by severe vasomotor and trophic disturbances. Peripheral vasospasms become frequent. The intensity of sensitivity disorders, paresthesia and pain increases. Vibration sensitivity is sharply reduced, hypoesthesia is segmental in nature. Symptoms of asthenia are expressed.

The diagnosis is established on the basis of anamnesis, sanitary and hygienic characteristics of working conditions, a set of clinical manifestations, as well as indicators of microcirculation, cold testing, determination of the threshold of vibration and pain sensitivity, skin thermometry, etc. During capillaroscopy of the nail bed, spastic atony of the capillaries is observed, less often their atony or spasm . Radiographs reveal proliferation of tubercles of the nail phalanges, thickening of the diaphysis and compact substance of the tubular bones, thickening of the trabeculae of the spongy substance, metaepiphyses of the phalanges, metacarpal and metatarsal bones.

Differential diagnosis is carried out with Raynaud's disease and other angiotrophoneuroses, syringomyelia, polyneuropathies (alcoholic, diabetic, etc.), vertebrogenic pathology of the nervous system.

2.2. Vibration reduction methods

Vibration can be caused by improper installation and operation of machinery and equipment, uneven wear of individual components.

Vibration damping is carried out using composite materials: steel - aluminum, steel - copper, as well as plastics, wood or rubber. Vibration-damping coatings are widely used, which, depending on the value of the dynamic modulus of elasticity, are divided into hard and soft . The former are effective at low frequencies, the latter at high frequencies.

The most effective coatings are made from viscoelastic materials, which include hard plastic, roofing felt, insulation, and bituminized felt with a layer of foil. The loss coefficient of such layered coatings is 0.15-0.40.

Soft vibration-damping coatings include soft plastics, rubber, foam, etc. The loss coefficient of such coatings is 0.05-0.5.

An effective method of vibration damping is the installation of dynamic vibration dampers that reduce the level of vibration of the protected object. The disadvantage of this method of vibration damping is that it is effective only at a certain frequency corresponding to the resonant vibration frequency of the unit.

Technical measures that reduce vibration isolation include the creation of new designs of tools and machines, the vibration of which should not go beyond the limits safe for humans, and the force applied by the hands of the worker to the manual machine should be within 15-20 kg. In such structures, vibration reduction is achieved by increasing the rigidity of the system by introducing stiffeners.

Vibration isolation provides vibration reduction by reducing the transmission of vibrations from the unit to the protected object by installing additional devices between them.

An important condition for reducing or weakening vibration is the rigid connection of machines and devices with their supporting bases, balancing of moving parts of machines. Proper placement and installation of equipment reduces the effect

Hygienic and therapeutic and preventive measures for vibration. In accordance with the regulations on the labor regime of workers in vibration-hazardous professions total time contact with vibrating machines, the vibration of which complies with sanitary standards, should not exceed 2/3 of the working day. Operations should be distributed among workers so that the duration of continuous exposure to vibration, including micro-pauses, does not exceed 15–20 minutes. In this case, two regulated breaks are recommended (for active rest, industrial gymnastics using a special complex, hydro procedures): 20 minutes (1-2 hours after the start of the shift) and 30 minutes - 2 hours after the lunch break.

Persons at least 18 years of age who have received the appropriate qualifications, passed the technical minimum according to safety rules and have passed a medical examination are allowed to work with vibrating machines and equipment.

Reducing the level of negative impact of vibration on health is facilitated by the use of personal vibration protection equipment (vibration-damping gloves, mittens and special shoes). Currently, the requirements for protective gloves and shoes using elastic-damping materials are regulated in special GOSTs. They contain standards for the effectiveness of vibration damping, the thickness of the elastic-deforming material, they indicate the purpose and scope of application and other requirements for individual means protection.

To increase the protective properties of the body, efficiency and work activity, you should use special complexes of industrial gymnastics, vitamin prophylaxis (2 times a year a complex of vitamins B, C, nicotinic acid), and special nutrition. It is also advisable to carry out 5-10-minute hydro procedures in the middle or at the end of the working day, combining baths at a water temperature of 38°C and self-massage upper limbs. 5

Vibration regulation

There are hygienic and technical regulation of vibrations.

Hygienic standardization vibration regulates parameters industrial vibration and rules for working with vibration-hazardous mechanisms and equipment, GOST 12.1.012 – 90 “SSBT. Vibration safety. General requirements", Sanitary standards SN 2.2.4/ 2.1.8.556 - 96 "Industrial vibration, vibration in residential and public buildings." The documents establish: classification of vibrations, methods of hygienic assessment, standardized parameters and their permissible values, working conditions for persons in vibration-hazardous professions exposed to local vibration, requirements for ensuring vibration safety and vibration characteristics of machines.

When hygienic assessment of vibrations, the normalized parameters are the root mean square values ​​of vibration velocity v(and their logarithmic levels L v) or vibration acceleration for local vibrations in octave frequency bands, and for general vibration - in octave or one-third octave bands. An integral assessment of vibration is allowed over the entire partial range of the standardized parameter, including the vibration dose D taking into account the exposure time.

For general and local vibration, the dependence of the permissible value of vibration velocity v t, m/s, from the time of actual vibration exposure not exceeding 480 min, are determined by the formula:

v t =v 480 ,

Where v 480 – permissible value vibration velocity for exposure duration 480 min, m/s.

Maximum value v t for local vibration should not exceed the values ​​determined for T=30 min, and for general vibration at T=10 min. 6

Technical limit vibration parameters not only taking into account the specified requirements, but also based on what is currently achievable for of this type vibration level equipment. Legislative documents have been developed that establish acceptable values ​​and methods for assessing vibration characteristics, which include GOST 12.1.012-78*. System of occupational safety standards. Vibration, general safety requirements and GOST 17770-72" (ST SEV 715-77). Manual machines. Permissible vibration levels.

The assessment of the degree of harmfulness of vibration of hand-held machines is carried out using the vibration velocity spectrum in the frequency range 11-2800 Hz. For each octave band within the specified frequencies, the maximum permissible values ​​of the root-mean-square vibration velocity and its levels relative to the threshold value equal to 5 10-8 m/s are established.

The mass of vibrating equipment or its parts held by hands should not exceed 10 kg, and the pressing force should not exceed 20 kg.

General vibration is normalized taking into account the properties of the source of its occurrence.

CONCLUSION

For several decades, there was no common understanding of the essence of the disease. Most often, the authors called it “angioneurosis”, “spastic angioneurosis”, “angioneurosis from concussion”, “white finger syndrome”, “Raynaud’s phenomenon”. For the first time, the possible harmful effects of vibration on the body of workers became known at the end of the last century. In 1924, M.E. Marshak described this disease in those working with pneumatic tools.

So, let us note that vibration is mechanical vibrations experienced by some body, and vibration disease is a disease that occurs in people working in professions closely related to vibration. The timing of the development of vibration disease depends on individual sensitivity to vibration - from 6-9 months to several years from the beginning of contact with vibration.

The pathogenesis of vibration disease is based on the process of parabiosis, which develops in various parts of the nervous system. First of all, the receptors of the hands or feet (depending on the nature of the work) are exposed to the damaging effects of vibration. From the receptors, the pathological process spreads to the peripheral nerves and takes on an ascending character. With prolonged exposure to vibration, parabiotic changes develop in the intervertebral nodes, in the spinal and cortical vibration centers of vibration. From here, the pathological process radiates to the vasomotor centers, which leads to the development of angiodystonic phenomena in the clinical picture of vibration disease.

Vibration disease can be local or general. General vibration disease can develop in people working in transport, in weaving and sewing shops, due to prolonged exposure to general vibration on the body. Local vibration disease can occur in people working with hammer drills, crushing machines, etc. and affects individual parts of the body.

The following methods are used to dampen vibration:

replacing tools or equipment with vibrating working bodies with non-vibrating ones in processes where possible (for example, replacing electromechanical cash registers with electronic ones);

the use of vibration isolation of vibrating machines relative to the base (for example, the use of springs, springs, rubber gaskets, shock absorbers);

usage remote control in technological processes;

use of automation in technological processes where vibrating machines operate (for example, control according to a given program)

use of hand tools with vibration-proof handles, special shoes and gloves. 7

In addition to technical methods to reduce vibration, it is also necessary to take hygienic and therapeutic measures.

LIST OF REFERENCES USED

Arustamov E.A., Voloshchenko A.E., Guskov G.V., Platonov A.P., Prokopenko N.A., Kosolapova N.V. Life safety: Textbook / Ed. Prof. E.A. Arustamova. – 10th ed. reworked and additional - M.: Publishing and trading corporation "Dashkov and Co", 2006. - 476 p.

Belov S.V., Devisilov V.A., Ilnitskaya A.V., Kozyakov A.F., Morozova L.L., Pavlikhin G.P., Perezhchikov I.V., Sivkov V.P., Smirnov S. .G. Life safety: Textbook for universities./ Belov S.V., Ilnitskaya A.V., Kozyakov A.F. and etc.; Under general ed. S.V. Belova. 7th ed., erased. – M.: Vys.shk., 2007. – 616 p.: ill.

Gritsenko V.S. Life safety : Textbook./Moscow State University economics, statistics and computer science. – M.: 2004. – 244 p.

Rusak O.N., Malayan K.R., Zanko N.G. Life Safety: Tutorial. 9th ed., ster./ Ed. HE. Rusaka. – St. Petersburg: Lan Publishing House, M.: Omega-L Publishing House LLC, 2005. – 448 pp.: ill. – (Textbook for universities. Special literature)

Internet resources

http://bgd.alpud.ru/_private/Vibrasiya/VIII_4_normy.htm

http :// sp. vuzunet. ru/ publ/ safe_ zhiznedejatelnosti/38_ normirovanie_ vibration_ zashhita_ ot_ vibration/13-1-0-270

http :// www. known. ru/ index. php? name= pages& op= view& id=1837

http :// med- lib. ru/ books/ nerv_ bol/121. php

http :// ru. wikipedia. org/ wiki/Vibration_disease

http :// ru. wikipedia. org/ wiki/Vibration

http :// bse. sci- lib. com/ article004721. html

http://delta-grup.ru/bibliot/16/71.htm

http://www.mining-enc.ru/v/vibracionnaya-bolezn/

10. http://exkavator.ru/articles/disease/~id=7831

1 Rusak O.N., Malayan K.R., Zanko N.G. Life Safety: Textbook 179 p.

2 Arustamov E.A. Life safety: Textbook 54 p.

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Vibration disease – complex pathological changes, which 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 disorders of 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 important parameters is the frequency of vibration, 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.

More high frequencies refer to ultrasound, which entails the transition of mechanical energy into thermal energy.

Acute form 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 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 (mild numbness) and minor painful sensations in the fingers, muscles of the shoulder girdle;
• rare finger spasms.

At this stage, all changes are reversible.

At stage II compensatory mechanisms the body is depleted. Its symptoms:

• persistent decrease in body temperature;
• decreased sensitivity of fingers;
• spasms in the upper fingers and lower limbs;
• 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.

The long course of vibration disease causes deep and varied disorders in 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;
• when cooling (and sometimes spontaneously), sharp whitening, and then an equally sharp blueing of one or both hands;
• thinning and deformation of the nail plates of the fingers;
• decreased sensitivity separate groups muscles 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);
• violation cerebral circulation(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 analysis blood, general analysis urine;
• 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;
• try white spot– the time of occurrence of spasm of blood vessels in the hands is estimated;
• 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 right hand and I 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 in case of vibration disease, they are aimed at restoring blood circulation and metabolic processes in muscle 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

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

Prevention

To prevent vibration disease for people whose work activity associated with constant exposure to vibration, it is necessary:

• 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 nutritiously, make sure that your diet contains sufficient quantity there were products containing vitamins B1 (bran, meat, liver, brewer's yeast, eggs, seeds) and C (rose hips, black currants, citrus fruits, bell pepper, tomatoes, onions, leafy greens).

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HEMODYNAMIC PREDICTORS OF PROGRESSION

angiodystonic syndrome in patients with vibration disease in combination with arterial hypertension

E. N. Koltyrina

Perm State Medical Academy named after. ak. E. A. Wagner, Perm

The purpose of this study was to study predictors of progression of angiodystonic syndrome (ADS) in patients with vibration disease (VS) in combination with arterial hypertension (AH). Workers of the floating crew (water transport) of the Kama River Shipping Company who had contact with general vibration (GV) were studied. An increase in vascular wall stiffness was detected in groups of patients at risk of developing VD and in patients with VD in association with hypertension, as well as a deterioration in diastolic myocardial function in patients with established diagnosis vibration disease. The presented complex of hemodynamic dysfunction is regarded as a predictor of progression of ADS in patients with VD in combination with hypertension.

Keywords: predictors of progression, angiodystonic syndrome, exposure to vibration.

Introduction

Development problem cardiovascular diseases still remains relevant, especially in the aspect of occupational medicine, since the health status of the working population determines the economic potential of the country.

In the context of the development of modern production, combined - general somatic and occupational - pathology is becoming increasingly important. Vibration disease (VD) and diseases associated with prevailing exposure to vibration remain the focus of attention of occupational pathologists and occupational medicine specialists.

Due to the increasing number of cases of combination of VD with diseases of the cardiovascular system, primarily arterial hypertension (AH), it has been classified in recent years as an occupational pathology.

Thus, when working in conditions of general vibration, the diagnosis of pathology of the vascular bed of target organs becomes of great importance. Peripheral angiodystonic syndrome (ADS) is characterized by a predominance in clinical picture phenomena of pronounced vascular dysfunction, with the progression of which transformation occurs into generalized angiotrophoneurosis.

The purpose of the study was to study predictors of progression of ADS in patients with VD in combination with hypertension.

Materials and research methods

The scope of observations included 105 floating crew (water transport) workers of the Kama River Shipping Company who had contact with general vibration (GV). The impact of hazardous agents was aggravated by the influence of such

associated production factors, such as production noise, unfavorable microclimate, physical and neuro-emotional stress, shift work.

The population of the subjects was represented by men aged 40-60 years, average age- 50.45±0.56 g. Patients were included in the study using simple random sampling. The first (I) group of the study (n=63) included workers at risk of developing VD. Of these, two subgroups were examined and identified: Ia - persons with hypertension (n=44), and Ib - persons without hypertension (n=19). The second (II) group of the study (n=42) consisted of workers with an established diagnosis of VD of degrees I and II, who were also divided into two subgroups: IIa - those with hypertension (n=34), IIb - workers without hypertension (n=8). Accordingly, patients were exposed to increased levels of low- and mid-frequency RH at their workplace. The main study groups were comparable in terms of work experience in their main profession, which ranged from 28.40±5.47 to 32.87±4.68 years. The control group (n=20) included patients with hypertension whose work was not related to occupational hazards and comparable by age (average age 49.71±1.1 years) and gender.

Program comprehensive examination, along with general clinical tests, included the study lipid spectrum and traditional tests for WB, as well as the study of central and peripheral circulation using computer oscillometry (COM), echo-CG, duplex scanning(DS) and rheovasography (RVG) of the vessels of the upper and lower extremities. This article presents data from instrumental studies: COM, DS, echo-CG.

Statistical processing was carried out using the Statistica for Windows program, version 6.0. Numeric data

presented as the arithmetic mean and standard error (M±5). For multiple comparisons, one-way analysis of variance was used; for two comparison groups, the null hypothesis was tested using the Wilcoxon, Mann-Whitney (U) and Kruskall-Wallis tests for multiple comparisons, correlation analysis (Rebrova O. Yu., 2002). The null hypothesis was rejected at the significance level p<0,05.

Results and its discussion

When analyzing vascular parameters using the COM method, it was revealed: in group 1a, the diameter of the brachial artery at rest was 0.55±0.01, in group Ib - 0.56±0.05, in group IIa - 0.43±0.02, in Group IIb - 0.54±0.04, in the control group - 0.52±0.02 cm. There is a more pronounced decrease in this indicator in patients with a combination of diseases of VD and hypertension, in comparison with patients with hypertension as in the risk group for the development of WB and in the control group (p<0,05). Вероятно, это указывает на более раннее развитие сосудистой дисфункции при влиянии ОВ и при наличии АГ у пациентов одновременно . Выявленные показатели снижения эластичности стенки плечевой артерии (ПА) в группах (Ь - 0,051±0,007 мм/мм рт. ст.; IIa - 0,05±0,01 мм/мм рт. ст., контрольная группа - 0,09±0,016 мм/мм рт. ст.) (р<0,05) и увеличение скорости пульсовой волны (СПВ) (990,12±15,36, 951,12±78,23, 651±149 см/сек соответственно) (р<0,05), могут косвенно свидетельствовать о некотором увеличении ригидности и о снижении эластичности сосудистой стенки у больных в группе риска по ВБ при наличии АГ и у пациентов с ВБ, страдающих АГ. Также была найдена отрицательная взаимосвязь уровня пульсового АД (ПАД) с податливостью артерии (ПА) (r=-0,27, p<0,05). Таким образом,

We found that PBP is accompanied by a significant increase in arterial stiffness, which is confirmed by data from other researchers.

When comparing the COM indicators of groups Ib and IIb, no significant differences were found; the indicators were within the generally accepted norms. However, attention is drawn to the fact that the highest indicator of arterial compliance (AA) and the lowest pulse wave velocity (PWV) were found in workers at risk of VD without hypertension - 0.07±0.01 mm/mm Hg. Art. and 863.35± ±28.69 cm/sec. This perhaps suggests a "positive" (stimulating) effect of general vibration on arterial stiffness. Pulse wave propagation velocity (PWV), which characterizes the state of the arterial vessel and its tone, was changed in all groups of subjects compared with the control group (p<0,05). Наибольшие показатели СПВ были у пациентов IIa группы и составила 990,12±15,36 см/сек. Предполагаем, что активизация симпато-адреналовой системы (САС) - bad influence increased pressure and general vibration - increases this indicator. When hypertension and VB are combined (group IIa), SAS reserves are depleted and PWV levels are recorded below 990.12±15.36 and 911.22±38.47 cm/sec (p<0,05), достоверной разницы между Ia и IIa группами выявлено не было (р>0.05). This indicates similar changes in the cardiovascular continuum in both groups. If in hypertension a functional mechanism with hypersympathicotonia is obvious, the result of which is a change in PWV, an increase in the density and sensitivity of receptors to catecholamines, then in VD the change in PWV presumably has a pathogenetic and morphofunctional basis.

PWV indicators in groups at risk of VD and hypertension (Ia) and VD in combination with hypertension (IIa) and in con-

role group were correlated with the thickness of the interventricular septum (IVS), the parameters of which were studied by echo-CG (r = +0.36, r = +0.33 and r = +0.23, respectively, p<0,05). Обращает на себя внимание то, что взаимосвязь скорости пульсовой волны и ремоделирования сердца была слабее при развитии вибрационной болезни, возможно, это связано с истощением резерва сердечно-сосудистой системы. Характер установленных связей косвенно подтверждают однонаправленность и параллелизм процессов ремоделирования сердца и сосудов при АГ, даже при наличии вибрационной болезни.

When assessing the systemic compliance of large arteries, it was found that the indicators of peripheral vascular resistance (PVR) in all groups of patients were within the accepted norms. Total vascular resistance (TVR) of the arterial bed includes the resistance of the aorta, great arteries and most muscular-type distributing arteries. It hardly changes or changes only to a small extent. It is worth noting the differences in the groups of patients at risk of VD with hypertension and without hypertension (1.85±0.23 and 1.25±0.05 ml/mmHg, respectively, p<0,05).

The value of total peripheral vascular resistance (TPVR) is variable and depends on the number of functioning capillaries in the systemic circulation included in the blood circulation, and almost does not depend on the tone of muscle-type vessels, in contrast to PVR. During the study, we found significantly high rates of total peripheral vascular resistance at rest in groups: Ia - 1512.24±54.36, Ib - 1190.81±71.20, IIa - 1614.67±24.44, IIb - 1568, 68±56.38, in the control group - 1560.87±14.11 dyn.*cm-5*sec.), which is also possible

may indicate vasoconstriction and a decrease in the adaptive capabilities of the blood circulation both in VD and in hypertension. The highest TPR was recorded in groups IIa - 1614.67±24.44, Ia - 1190.81±±71.20 and Ib - 1560.87±14.11 dyn.*cm-5*sec (p<0,05), что, возможно, обусловлено выраженным влиянием вибрации на развитие дистрофии периферических сосудов и повышение их жесткости. Ангиоспазм и ангио-склероз при ВБ являются анатомическим субстратом увеличенного ОПСС, а при АГ функциональным субстратом увеличения ОПСС является выключение части функционирующих капилляров большого круга кровообращения (БКК) из перфузии. Причинами такого выключения, как анатомического, так и функционального, являются закупорки мелких артерий, разрушения капиллярного русла БКК, спазм мелких артерий.

The specific peripheral resistance (SPR) in the groups was: Ia - 32.76±5.68, Ib - 28.90±6.21, IIa - 38.00±±3.56, IIb - 32.56±8, 67, control group - 39.58±4.62 arb. units The change in UPSS in patients with VD and when VD is combined with hypertension (groups IIa and IIb) occurs due to an increase in the length of resistive vessels and capillary tortuosity, a decrease in the extensibility of the walls of resistive vessels, as well as an increase in the tone of vascular smooth muscles. It is worth noting the difference in UPSS between groups L and Na (32.76±5.68 and 39.58±4.62 conventional units, p<0,05). УПСС в IIa и IIb группах составил 38,00±3,56 и 32,56±8,67 усл. ед. (р<0,05), что указывает на негативное действие АГ на жесткость сосудов.

We also analyzed in detail the duplex scanning (DS) parameters of the vessels of the upper and lower extremities in patients at risk for vibration disease in combination with hypertension, who have signs of vascular remodeling of blood vessels, in contrast to patients without them

signs. The average PWV value in patients with intima media complex (IMC) thickness greater than 0.9 mm was 983.4±0.9 mm, in patients with normal IMC thickness - 834.4±1.2 mm (p<0,05). Толщина КИМ коррелировала с СПВ (r=+0,40, p<0,05), с возрастом (r=+0,56, р<0,05). Увеличение СПВ было выявлено у 76,4% пациентов с утолщением КИМ. В группе с ВБ и АГ увеличение СПВ было выявлено у 51,2% пациентов с утолщением КИМ, что говорит об увеличении жесткости сосудистой стенки с прогрессированием ангиоспазма и развитием ангиосклероза.

Interesting patterns were noted and significant differences were identified when examining patients using echo-CG in groups with and without hypertension. In patients with a history of hypertension, based on echo-CG, a significant increase in indicators characterizing the posterior wall of the left ventricle (PLW) and the interventricular septum (IVS) was established: in group Ia, the thickness of the LVPS is 11.04 ± 1.41 mm, the thickness of the IVS - 10.02±3.21; in group IIa - 11.98±0.91 and 11.13±2.97 mm, respectively. In the control group, the thickness of the LVSD was 11.38±1.13 mm, the thickness of the IVS was 11.40±1.20 mm. In group Ia there were no significant changes in the IVS indicator (10.02±3.21) in comparison with patients from the control group. In the groups without hypertension, no significant differences from patients in the control group were found in these indicators. The presented changes indicate the development of left ventricular myocardial hypertrophy, which speaks in favor of the negative effect of high blood pressure on the heart (Table).

A significant difference in the following indicators was shown in patients with vibration disease in combination with hypertension: stroke volume (SV) - 60.53±10.4 and 70.29±6.38, respectively (p<0,05), а также конечный

Indicators of the structural and functional state of the myocardium in the studied groups

Indicator Normal Risk group for vibration disease Vibration disease Control group (n=20)

Have hypertension (n=19) No hypertension (n=19) Have hypertension (n=15) No hypertension (n=8)

LV (s), mm (ESR) 25-40 34.41±1.12 #2 39.33±1.55 #1, 3, 4, 5 32.87±5.17 #2 35.69±2 .34 #2 34.49±1.94

LV (d), mm (EDR) 35-56 50.64±5.72 52.66±1.57 47.33±4.81 52.81±6.04 53.90±2.04

ESR, ml 22-74 49.60±2.88 #2, 3 58.39±8.34 #1, 3, 5 40.33±7.25 #1, 2, 4 51.20±7.29 #3 46.51±8.74

EDV, ml 54-160 121.80±9.28 #3 130.53±12.04 #3 100.64±14.27 #1.2.4.5 121.96±9.68 #3 126, 99±8.06

SV, ml 70-99 74.82±2.32 #3.5 71.42±5.88 #3.5 60.53±10.4| #1, 2, 5 70.29±6.38 #3, 5 80.26±3.69

LA, mm 20-38 33.40±1.28 #4.5 31.55±4.45 #4.5 38.86±2.67 #4 29.64±2.38 #1, 2, 3 , 5 37.31±2.15

IVS, mm 7-11 10.02±3.21 7.76±4.82 #3.5 11.13±2.97T #2.4 7.29±2.39 #3.5 14.40± 1.20T

LSV, mm 7-11 11.04±1.41T #2, 4 7.33±3.22 #1, 3, 5 11.98±0.91T #2, 4 8.21±1.27 #1 ,3.5 11.38±1.13T

EF, % 55-70 60.40±3.12 #2.5 55.63±2.36 #1, 3.5 61.47±3.47 #2.4 55.31±4.02 #3 65.29±3.15

Note. * - significant differences between groups (M±5).

diastolic volume (DV) - 100.64±14.27 and 121.96±9.68 ml (p<0,05). Внутри группы риска на развитие ВБ у работников, имеющих АГ и без АГ, показатели КДО и УО достоверно не отличаются. Обращает на себя внимание разница показателей УО и КДО у больных с риском ВБ и с АГ и у больных ВБ в сочетании с АГ: УО - Ia группа - 74,82±2,32, IIa группа - 60,53±10,4 (р<0,05); КДО -121,80±9,28 и 100,64±14,27 мл соответственно (р<0,05).

When analyzing the relationships between COM parameters and echo-CG, we identified a certain significant increase in ejection fraction (EF) in individuals with increased PAP without exposure to OB. There is also a natural tendency to increase SV in the same group (SV - 80.82±2.32 ml, EF - 65.29±3.15%, r=+0.44, p<0,05). В связи с этим

we can conclude that the heart is working uneconomically. There were no significant differences in other echo-CG indicators (Table). The assessed changes provide evidence of an earlier development of diastolic and systolic dysfunction in workers suffering from VD. This undoubtedly leads to the early development of heart failure and disability, a decrease in the quality of life of patients, as well as a decrease in the labor force of the examined population.

Thus, when analyzing vascular dysfunction using volumetric computer oscillometry in groups of patients at risk of developing VD and in patients with VD in association

tion of hypertension revealed a significant decrease in the compliance of the artery wall and, accordingly, an increase in the pulse wave speed, as well as an increase in the total and specific peripheral resistance, which indicates an increase in the rigidity of the vascular wall. We obtained results indicating hemodynamic evolution from the central and peripheral hemodynamics not only in the presence of vibration disease in the association of hypertension, but also in the risk group for the development of VD in combination with hypertension. Patients with hypertension in this group are characterized by high rates of cardiac propulsive activity with a relatively low value of peripheral vascular resistance in comparison with patients diagnosed with VD. Based on the results of echo-CG, the identified changes fit into the idea of ​​the pathological effect of high blood pressure on the body with the development of left ventricular myocardial hypertrophy, as well as deterioration of myocardial diastolic function in patients with an established diagnosis of vibration disease. We regard the presented complex of hemodynamic dysfunction as a predictor of progression of ADS in patients with VD in combination with hypertension.

BIBLIOGRAPHICAL LIST

1. Agafonov A.V. Clinical and structural-functional features of the state of the heart and vessels of elastic and muscular types, their prognostic significance in older patients with arterial hypertension: abstract. dis. ...Dr. med. the science. V. Agafonov. - Perm, 2007. - 48 p.

2. Malyutina N.N. The problem of arterial hypertension at industrial enterprises in Perm/N. N. Malyutina, V. V. Shchekotov, T. M. Lebedeva, E. A. Titova, A. A. Titov,

T. N. Govyazina / [Bulletin of the scientific council “Medical and environmental problems of workers.” - 2004. - No. 3. - P. 96-98.

3. Denisov E.I. Periodic medical examinations and occupational diseases/E. I. Denisov, P. V. ChesaliN///Bulletin of the scientific council “Medical and environmental problems of workers.” - 2006. - No. 4. - P. 30-33.

4. Suvorov G. A General vibration and vibration disease / G A. Suvorov, I. A. Staro-zhuk, L. A. Tarasova, - Togliatti: DIS JSC "AvtoVAZ", 2000. - 152 p.

5. Sukharevskaya T. M. Microangio- and visceropathies in vibration disease / T. M. Sukharevskaya, A. V. Efremov, G. I. Nepomnyashchikh. - Novosibirsk, 2000. - 140 p.

6. Effect of different rest intervals after whole-body vibration on vertical jump performance/^. C. Dabbs, C. X. Munoz, T. T. Tran, L. E. Brown, M. Bottaro//]. Strength. Cond. Res.- 2011.- Vol. 25.- No. 3.- R. 662-667.

7. Effect of low-magnitude, high frequency vibration on osteogenic differentiation of rat mesenchymal stromal cells/E. Lau, W. D. Lee, J. Li, A. Xiao, J. E. Davies, Q. Wu, L. Wang, L You //]. Orthop. Res.- 2011.- Vol. 22.-No. 10.-R. 213-234.

1

Borodulina E.V. 1Eliseeva L.N. 2

1 Medical and sanitary unit of the Directorate of the FSB of Russia for the Krasnodar Territory (hospital)

2 State Budgetary Educational Institution of Higher Professional Education "KubSMU" of the Ministry of Health and Social Development of Russia, Krasnodar

The results of a retrospective analysis of diseases of the digestive system among seafarers (ship specialists) and coastal seafarers over a 27-year period of time are presented. In the structure of therapeutic morbidity in this category of men, diseases of the digestive organs have for many years taken second place after cardiovascular diseases. Moreover, one of the main places belongs to acid-related diseases both among ship specialists and coastal sailors. It has been established that among ship specialists, signs of damage to the digestive system are detected more often, and also appear at an earlier age and depend on the length of navigation. Diseases of the gastrointestinal tract in this cohort of men are the main reason for separation from work, disqualification for health reasons and dismissal from the crew.

seafarers (ship specialists)

coastal seafarers

diseases of the digestive system

1. Arkhipovsky V.L., Savin V.F., Mozer A.A. On the role of ship doctors in the merchant fleet // Marine medicine on the threshold of the new millennium: mat. scientific-practical conf. – St. Petersburg, 2002. – pp. 38-40.

2. Beloborodova S.V. Medical and social aspects of the incidence of peptic ulcer disease among military sailors in the North / S.V. Beloborodova, I.A. Oganezova, V.M. Manuilov // Bulletin of SSMU. − Arkhangelsk, 2003. − No. 1. – P. 10-11.

3. Naval therapy: textbook. allowance / ed. Simonenko V.B., Boytsova S.A., Emelyanenko V.M. – M.: Medicine, 2003. – 512 p.

4. Kazakevich E.V. Features of epidemiology and prevention of risk factors among seafarers: abstract of thesis. diss. ... doc. honey. Sci. – M., 1997. – 36 p.

5. Kamalutdinov S.R., Popov V.V. Dynamics of arterial hypertension and other risk factors for cardiovascular diseases in sailors during long sea voyages: monograph. – Arkhangelsk: Publishing House of the Northern State Medical University, 2010. – 101 p.

6. Kolesnikova I.Yu. Quality of life, psychological status and features of the course of the disease in patients with peptic ulcer // Klin. honey. – 2001. – No. 6. – P. 446.

7. Kiryanov Yu.I. Organization and structure of therapeutic assistance to military personnel of the Arkhangelsk region TSMO / Yu.I. Kiryanov, I.A. Oganezova, A.V. Ivakhnov // Bulletin of SSMU. − 2002. – No. 1. − P. 39-40.

8. Myznikov I.L. [and others] Dynamics of morbidity among sailors depending on the length of service in the crew // Marine. honey. magazine − 2001. − No. 2. − P. 29-32.

9. On psychophysiological indicators in assessing the performance, fatigue and overwork of sailors / I.A. Bloshchinsky, A.F. Kiselev, V.N. Maksimenko et al. // Military medical. magazine – 2002. – No. 10. – P. 58-65.

10. Oganezova I.A. Clinical and psychological features of the course of peptic ulcer disease in military personnel in the European North / I.A. Oganezova, A.V. Ivakhnov, V.M. Manuilov // Military medical. magazine – 2003. – No. 7. – P. 48-51.

11. Chumakov V.V., Sharaevsky G.Yu. The level of habitability is a combat property of a ship // Marine collection. – 1998. – No. 11. – P. 12-26.

Introduction

One of the problems of marine medicine is maintaining the professional performance of seafarers. Among sailors (ship specialists), diseases of the digestive system are of particular relevance, as they cause a high level of labor losses and hospitalizations, lead to decommissioning from the crew and dismissal. The dismissal rate of ship specialists due to pathology of the gastrointestinal tract is in second place, and the number of people suffering from diseases of the digestive system is constantly increasing. The occurrence of diseases of the above classes in seafarers is directly dependent on the living conditions on board the ship and the nature of the work performed. Members of the ship's crew are forced to remain for a long time in conditions of round-the-clock continuous exposure to a complex of specific factors: increased levels of noise and vibration, low levels of artificial illumination, increased levels of infrared radiation, electromagnetic fields, neuro-emotional stress, disruption of circadian rhythms due to the need to carry night duty. Sailors are in a state of chronic stress during a voyage, accompanied by poor nutrition (not following a diet, eating at different times of the day, poor nutrition). Seafarers, having a high motivation to keep their jobs, in order to avoid disqualification for health reasons, go to medical institutions little or not at all, and carefully hide their illnesses, which is well known and noted in many studies.

Purpose of the study

To conduct a retrospective analysis of the structure and features of the development of diseases of the digestive system among ship specialists in comparison with coastal sailors.

Materials and methods

The study was carried out retrospectively, by analyzing a sample of data from medical documentation: medical books, hospital records, sheets of dispensary examinations with a periodicity of 3 years. The health status and morbidity of the gastrointestinal tract from 18 years of age to 45 years were taken into account. The work includes data on 60 men, 30 of whom are ship specialists (surface ship crew) - group 1, and 30 coastal sailors - group 2. The choice of groups was determined by the homogeneity of the duties performed and approximately the same social and living conditions, and group 1 included sailors who had at least 15 years of experience as a seafarer.

Statistical analysis of the data was performed using the Statistica 6.0 software package, and the significance of the frequency differences was determined.

Results and discussion

Analysis of the information obtained revealed that at the age of 18, all subjects were in the stage of optimal health and stabilization of vital functions. Upon completion of educational institutions (23-24 years old), all the subjects were considered fit to join the crew, although 3.3% of the subjects in group 1 were diagnosed with chronic gastroduodenitis (CGD) without dysfunction and with rare exacerbations. This may be a reflection of the difficulties of adapting to new living conditions and professional activities, since there is a change in both the nature and quality of food, and there is also a psychotraumatic factor, especially during the adaptation period.

At 27 years old, sailors of both groups have 4 years of professional experience. During this period, diseases of the digestive system continue to increase to 10% and 3.3%, respectively, in groups, mainly due to erosive gastroduodenitis (6.7/3.3%), gastroesophageal reflux disease (GERD) by 3.3% in both groups . This can be associated with the most common factors characteristic of military service conditions: physical activity leading to an increase in intra-abdominal pressure (weight lifting); irregular food intake, consumption of spicy, fried foods, carbonated drinks, as well as dry food, psycho-emotional overload.

At 30-33 years of age (7-10 years of experience on board and on shore), the incidence of diseases of the digestive system is 13.3-16.6% and 10-13.3% of cases, respectively, for the groups. Sailors of group 1 are diagnosed with duodenal ulcer (DU) in 3.3% of cases. The early debut of duodenal ulcers among ship specialists may be associated with difficult operating conditions and higher psycho-emotional stress than among coastal sailors

At 36-39 years of age (13 years of service on board and on shore), diseases of the digestive tract continue to increase, 33.4-40% and 16.6-23.3%, respectively, for the groups, chronic cholecystitis (CC), chronic pancreatitis ( HP).

At 42 years of age, the morbidity pattern for this class has not changed. At the age of 45 (by this age, the experience on board and on shore is more than 15 years), the increase in diseases of the digestive system continues, mainly due to CGD and GERD in both study groups. Ship specialists who had a peptic ulcer after undergoing a medical examination were written off ashore or dismissed in the presence of severe cicatricial deformation of the duodenal bulb.

The age-related dynamics of the growth and prevalence of diseases of the digestive system of the studied population of men is clearly shown in Tables 1, 2, 3.

Table 1 - The structure of diseases of the digestive system among ship specialists, depending on age and length of service in the crew, n=30

Age,	Service life at sea, years		GERD, esophagitis		YaBLDPK

table 2- Structure of diseases of the digestive system among coastal seafarers, depending on age and length of professional activity, n=30

Age,	Lifetime ashore		GERD, esophagitis		YaBLDPK

Table 3 - Comparative analysis of the occurrence of diseases of the digestive system among ship specialists and coastal sailors

Age,	Service life, years	Sea (n=30)	Land (n=30)

* - statistical significance of frequency differences in comparison with the corresponding

a subgroup of coastal sailors.

conclusions

1. Thus, our retrospective analysis of dynamic changes in the state of the gastrointestinal tract of sailors over 27 years shows that ship specialists earlier and more often show signs of damage to the digestive system, which cause a high level of labor losses and hospitalizations, lead to decommissioning from the crew and disqualification for state of health.
2. Duodenal ulcer in sailors (ship specialists) most often leads to disqualification and dismissal from the crew.
3. One of the main places in the structure of gastrointestinal morbidity in both groups is occupied by acid-dependent diseases: chronic gastritis (gastroduodenitis), GERD, gastric and duodenal ulcers, chronic pancreatitis.

Thus, maintaining the health of sailors (ship specialists) continues to be a complex and multifaceted problem, including the study of the incidence of peptic ulcer disease in sailors is an urgent task for marine medicine. We believe that analysis of the significance of each of the factors present on the ship that negatively affects the health of sailors, and the development of measures to prevent the development and progression of diseases of the digestive system will increase the length of professional activity of this cohort of men.

Reviewers

• Pasechnikov V.D., Doctor of Medical Sciences, Professor, Head of the Department of Therapy, State Budgetary Educational Institution of Higher Professional Education "StSMA" of the Ministry of Health and Social Development of Russia, Stavropol.
• Skibitsky V.V., Doctor of Medical Sciences, Professor, Head of the Department of Hospital Therapy, KubSMU, Ministry of Health and Social Development of Russia, Krasnodar.

Bibliographic link

Borodulina E.V., Eliseeva L.N. COMPARATIVE ANALYSIS OF THE FREQUENCY AND PREVALENCE OF DISEASES OF THE DIGESTIVE SYSTEM IN SHIP SPECIALISTS AND COAST SAILORS // Modern problems of science and education. – 2012. – No. 3.;
URL: http://science-education.ru/ru/article/view?id=6244 (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 JSC 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, research work devoted to a comprehensive hygienic assessment of working conditions and the study of the health status of seafarers and modern conditions little, and the available information is often contradictory. The foregoing justifies the relevance of carrying out scientific research, dedicated 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:

■ - provide scientific justification for the system of preventive measures and recommendations for occupational safety and health of workers on ships navy V 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.

Analysis of literary data indicates that large quantities works devoted to the problem of studying living conditions and the level of health 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 a vast coastal area Pacific Ocean. Currently, the company has 90 ships of various series and types, which employ about 8.5 thousand sailors. Socio-economic transformations recent years, undoubtedly influenced the state and development of the navy. 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 research showed that the microclimate parameters at the main workplaces of the surveyed ships varied significantly and according to Guideline 2.2.755.99 “Gen-Gieshpe assessment criteria and classification of working conditions according to indicators of harmfulness and danger of working environment factors, severity and tension labor process)) were assessed 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. During the cold period of the year, the air temperature at workplaces was often recorded here below the lower permissible limit, in warm times - above the upper limit permissible norm. 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, the microclimate parameters, as a rule, met the requirements of the 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, insufficient artificial lighting should be considered an extremely unfavorable production factor. It is known that prolonged exposure to artificial lighting contributes to depression visual analyzer, a decrease in the overall performance of a person, 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. Concentration 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. Carrying out special research in the residential and public premises of the 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 in the course of our research elevated levels noise was recorded in the power department, ref. department, tiller room, 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 production noise parameters were found in the energy department. The noise here is usually constant, broadband. Actual sound pressure levels in octave bands with geometric mean frequencies 31 - 8000 Hz exceeded the standardized levels by 4-34 dB. Studying spectral characteristics noise made it possible to identify the predominance of mid- and high-frequency components. Sound levels at key workplaces exceeded the maximum permissible levels 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) of 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 funds 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. Worst Conditions labor (and this does not depend on the type of vessel) in the energy department. The main occupational hazards in this department are heat:. the microclimate of the hollows is caused by significant heat release from operating mechanisms, insufficient artificial lighting in the absence of natural lighting, polluting the air environment with fuel combustion products, high levels noise and vibration. Mechanical and electrical workers have contact with elevated temperature 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 seagoing 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, caused by frequent stressful situations I the specifics of the work of maritime transport (personal risk, responsibility for the safety of 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 prolonged concentrated observation, a large number objects of simultaneous observation, the need to monitor the screens of video terminals, the 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 continuous operation at sea, sailors experience a pronounced development of processes of decreased performance, instability of emotional and emotional states. 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) degrees. 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).

4. Comprehensive studies of working conditions on ships of the Norilsk SA-15 series of the Sakhalin Shipping Company, as the basis for the development of measures to improve them // Hygiene of long voyages: Abstracts of scientific conference reports. - Leningrad, VMA named after. Kirov, 1989. - S.Z. (co-authors G.A. Zayats, A.N. Zvo-lnsky).

5. Complex multiple investigations of labor conditions on board fishing vessels in the far-eastern region // Abstracts, XI International Symposium on Marine Medicine, Poland, Gdynia, 1989. - Gdynia, 1989. - P. 168 (F.L. Aikashev, A.N. Zvolinsky ).

6. A study of work conditions on board of fishing vessels in the far-eastern region H Abstract, Bull. Inst. Trop. Med. Gdynia, Poland, 1990, 41, 1-4 (F.I. Aikashev, A.N. Zvolinsky).

7. Hygienic assessment of the working conditions of the crew on ships of the Nikolai Malakhov series // Medical and social problems of protecting public health in the Far East: Collection of materials from the anniversary scientific conference. - Vladivostok, 1991. 148-149. (co-author A. Ya. Molchanov).

8. Hygienic assessment of the working conditions of the crew on ships of the Karl Libk-Iecht series // Current issues of hygiene and ecology of transport: Collection of thematic scientific and practical conference. - Ilyichevsk, 1992. - p. 91. (co-authors A. N. Zvo-linsknn, B. M. Zubakov).

9. Social and hygienic aspects of working conditions, health of the crew of OJSC "Far Eastern Shipping Company" // Primorskie Dawns: Collection of scientific papers of the First Regional Scientific and Technical Conference, - Vladivostok, 1998. - p. 162-163. (co-authors A. A. Sheparev, S. V. Pererva, R. A. Shifelbein).

10. Brief historical data. Marine medicine. Paths of development // Vologda readings. Ecology and life safety: Collection of abstracts of a scientific and technical conference. - Vladivostok, 1998. - p. 5-6. (co-author A. A. Shchspa-rev).

11. Hygienic assessment of the working conditions of the crewman on ships of the Norilsk SA-15 series of JSC Sakhalin Shipping Company // Primorskie Dawns - 99: collection of reports of the scientific and practical conference. - Vladivostok, 1999. - p. 18-21. (co-authors A.A. Shepzrev, E.V. Sotnikova, O.V. Shakshueva).

12. Content of harmful substances in the exhaust gases of marine diesel engines of the floating base “Pavel Zhitnikov” // Materials of the Regional Far Eastern Scientific and Practical Conference “Modern aspects and problems of labor protection, life safety in fishery organizations of the Far Eastern Basin-99”. - Vladivostok, DVIPC, 1999. - p. 33-35. (co-authors F.I. Aikashev, N.I. Burlakova).

13. Design and technical features affecting the health of ship crews // Materials of the Regional Far Eastern Scientific and Practical Conference “Modern aspects and problems of labor protection, life safety in fishery organizations of the Far Eastern Basin-99”. -Vladivostok, DVIPC, 1999. - pp. 55-56. (co-author A.N. Zvolinsky).

14. Hygienic assessment of the working conditions of the crew on ships of the MRKT “Stitul” type of JSC “Super” // Materials of the Regional Far Eastern Scientific and Practical Conference “Modern aspects and problems of labor protection, life safety in fishery organizations of the Far Eastern Basin-99”. - Vladivostok, DVIPC, 1999. - p. 92-93. (co-authors P.A. Schiefelbein, L.I. Zyrnova).

15. On the issue of the influence of monotony of work on the work of the crew members of the MRKT “Mechanik Kovtun” JSC “Super” // Materials of the Regional Far Eastern Scientific and Practical Conference “Modern aspects and problems of labor protection, life safety in fishery organizations of the Far Eastern Basin-99”. - Vladivostok, DVIPC, 1999. - . 94. (co-authors P.A. Schiefelbein, L.I. Zyryanova).

16. Podkhols, assessment of working conditions and the punishment of sailors under voyage conditions, taking into account harmfulness, risk factors, severity and intensity of work // Ecology, life safety, labor protection. and sustainable development of the Far Eastern territories: Scientific readings “Primorskie Dawns - 2000”, April 18-19, 2000, Vladivostok, Administration of the Primorsky Territory, Far Eastern State Technical University, TANEB.

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).

Bibliography Konovalov, Yuri Vasilievich, dissertation on the topic Labor protection (by industry)

1. Abakumova A.A., Odintsova V.D. Study of the state of the cardiovascular system in persons of operator professions in the fleet // Man and Vessel 2000. Abstracts report X International Symposium on Marine Medicine. M., 1986. - p. 129-131.

2. Azhaev A.N., Priemsky Yu.I. On the problem of microclimate regulation in military equipment facilities //Military Medical Journal. 1984. - No. 5. - With. 43-44.

3. Akatova P.S., Chertok A.G. Features of working conditions and morbidity of women on merchant fleet ships // Health of the population of the Far East. Vladivostok. -1996. -With. 21-22.

4. Analysis of the main surgical diseases and injuries of sailors /S.I. Korkhov, A.P. Dotsenko, V.P. Rubetskaya, A.P. Lunev // VII International Symposium on Marine Medicine, September 23-30, 1976. p. 23-30.

5. Arzumanov A.A. The state of the protective functions of the sailors’ body // Military Medical Journal -1994 -No. 5. With. 45-49.

6. Asmolov A.K., Lobenko A.A. Adaptation of sailors during a transmeridial voyage // Medical and social aspects of the “Man-Ocean” problem - Vladivostok, 1988. 110-111.

7. Asmolov A.K. Functional state of the body of sailors during navigation // Human Physiology. 1990. - T. 46, No. 1. - p. 141-148.

8. Bozhanov N. When a ship is sinking: Problems of combating hypothermia of the body. // Marine fleet. 1997, - No. 2. -With. 16-17.

9. Yu. Balakirev E.M. Reducing occupational injuries on fishing vessels // Proceedings of the Third International Symposium on Marine Medicine. -M. 1969. - p. 179-185.

10. P. Balunov V.D., Barsukov A.F., Artamonova V.G. Clinical and functional assessment of the health status of workers exposed to infrasound, noise and general vibration // Occupational Medicine and Industrial Ecology. 1998. - No. 5. With. 22-26.

11. Basolaeva V.G., Loburenko A.P. Hygienic regulation of new chemicals for ship equipment//Medical and social problems "Ocean Man" Vladivostok, 1988. - p.62.

12. Belyaev A.F., Belyaeva N.E. Inter-trip rehabilitation of fishermen in a local sanatorium // International Journal of Immunorehabilitation. 1995,- No. 1.-p.41.- 112

13. Belyaev A.F., Matsevich L.A. Ship health resorts and modern problems of marine medicine. Vladivostok, 1991. - Ch. 8.3 - p. 194-198.

14. Berdyshev V.V. The influence of Eleutherococcus on body functions and the performance of sailors in swimming // Military Medical Journal. 1981. -№2. - With. 48-51.

15. Berdyshev V.V., Grigorenko G.F. Some ways to accelerate adaptation and increase the performance of sailors in navigation // Valeology: Diagnostics, means and practice of ensuring health. 1993. - Issue. 1.-e. 223-239.

16. P. Berdyshev V.V., Grigorenko G.F. Peculiarities of seafarers’ work and issues of adaptation when sailing in low latitudes: Methodological manual. Vladivostok: B.I., 1982. -p. 149.

17. Berdyshev V.V. The use of Eleutherococcus to normalize the body condition of sailors in the tropics // Adaptation and adaptogens. Vladivostok, 1977, - p. 119-125

18. Berdyshev V.V., Novozhilov P.I. Features of the course of readaptation processes in sailors after sailing in the tropics // Abstracts of the 2nd All-Union Conference on Human Adaptation. Novosibirsk, 1978, p.55-56.

19. Berdyshev V.V. On some indicators of human adaptation to the conditions of the humid tropics //Military Medical Journal. 1982. - No. 3. - p.45-47.

20. Biorhythms and performance of sailors under conditions of hypokinesia / O.Yu. Netudykhatko, A.I. Akulin, A.P. Stoyanov, V.T. Kravets // Military medical journal 1990. No. 7. p.64-65.

21. Balos M., Helban A. Some aspects relating to the personality of seafarers // UP International Symposium on Marine Medicine, September 22-23. -M., 1976. -p.52.

22. Bortnovsky V.N. Determination of tolerance to physical activity in sailors while swimming // Military Medical Journal 1983. - No. 1. - p.57.

23. Bruskin 3.3. Some considerations regarding hygienic standards and assessment of industrial noise and vibration // Occupational Medicine and Industrial Ecology. 1994. - No. 7. - With. 15-18.

24. Bukharin E.A., Svistunov N.T., Tepina L.G. Medical control of the microclimate of ship premises P Military Medical Journal -1985. -№1.-p.55-57.

25. Bychikhin N.P., Vasilyeva T.V. Specifics of labor processes of Arctic fleet vessels and their influence on some body systems // Hygiene and Sanitation. -1989. No. 5. -p.22-23.

26. Vasilyev T.V., Ponomareva A.G. Current issues in the prevention of diseases among sea transport personnel // Soviet Healthcare. 1989. - No. 8. - With. 51-55.

27. Venulavih Zygmunt Preliminary ergonometric assessment of workplaces and living conditions of the crew on merchant ships of the new series of m/v "Ignaci Daimińske" // Healthcare. -1989. No. 1, p.65-71.

28. Vinnikova V.N., Dombrovsky A.Yu., Zhuravleva V.E. Introduction of health-improving physical education on fishing vessels // Healthcare of the Russian Federation. 1989. - No. 5. - p.27-30.

29. Vinogradov S.A., Vorobyov A.A., Turevich G.T. The resulting temperature as the calculated hygienic standards for the microclimate of ship's air-conditioned premises // Medical and social aspects of the "Man-Ocean" problem. Vladivostok, 1988. -p. 64.

30. The influence of physical inactivity during a voyage on the performance and health status of high-speed fleet workers /A.M. Voitenko, V.I. Vigovsky, G.I. Galostnykh and others // VII International Symposium on Marine Medicine September 2230. M., 1976. - p. 37.

31. Influence on water metabolism of emergency rations of various compositions / M.T. Popov, S.A. Bugrov, P.A. Kozinsky et al. and International Symposium on Marine Medicine September 23-30. M., 1976. - With. 90.

32. The effect of a new Eleutherococcus drug on physical performance/T. A. Povar, I.I. Kokhaeva, A.I. Afonichev and others // Russian national conference "Man and Medicines" Moscow, April 8-12, 1997. Abstracts, reports - M., 1997. - p. 175.

33. The influence of ship noise on sailors during long voyages / S.A. Rodzievsky, A.A. Voyakhov, A.B. Tgrevsky and others // Occupational hygiene and prof. diseases. -1983. -No. 3. p.48-50.

34. The influence of training physical activity on the functional state of the body of sailors during a long voyage / M.A. Grebenyuk et al. // Military medical journal. 1992. -№10. -With. 60-62.

35. Vozhzhova A.I., Zakharov V.K. Protection from noise and vibration on modern types of transport. L.: Medicine, 1968. - p. 326.

36. Impact of the Environment and the work of crew members of sea vessels / E.I. Tsivinsky, S.I. Eidelshtein, A.I. Gerasimov et al. // VII International Symposium on Marine Medicine, September 23-30 - M., 1976. p. 47.

37. Possibilities of primary psychoprophylaxis of diseases among sailors during long voyages / M.S. Denisyuk, T.V. Rozhkovsky, M.V. Batyuk et al. // Abstracts of the 18th Congress of Therapists “Pre-illness - recovery”. - M., 1981. - pp. 38-40.-114

38. Voitenko A.M. Hygienic aspects of habitability of naval vessels // Current state, prospects for the development of marine medicine and hygiene of water transport: Materials of the All-Union Conference M., 1983. - pp. 97-98.

39. Voitenko A.M. Dependence of morbidity among sailors on some ship factors // International Symposium on Marine Medicine, September 23-30, 1976. M., 1976. - p. 12.

40. Voitenko A.M. Development of research on the problem “Scientific foundations of hygiene and physiology of human adaptation to the conditions of the World Ocean” // Hygiene and Sanitation. 1993. - No. 2. - pp. 8-10.

41. Voitenko A.M., Shafran JIM. Hygiene of habitability of sea vessels. -Kiev: Health, 1989. -p. 131.

42. Voitenko A.M., Shafran L.M., Lisobey V.A. Scientific and technological progress and problems of health protection of water transport workers // Occupational Hygiene and prof. diseases. - 1992, - No. 2. p. 3-5.

43. Voitenko S.B. The effectiveness of physical exercises in the work regime of long-distance sailors // Medical and social aspects of "Ocean Man". Vladivostok, 1988. -p. 115.

44. Hygienic assessment of air conditioning methods on sea vessels / Yu.A. Rakmanin, T.V. Strikolenko, A.M. Voitenko // Hygiene and sanitation. 1991. -№1.-p.17-19.

45. Hygienic assessment of working conditions on refrigerated ships of the "Karl Liebhnecht" type / Yu.V. Konovalov, A.N. Zvolinsky, B.M. Zubakov and others // Abstracts of reports of the thematic scientific-practical conference: Il-ichevsk, 1992. - p. 91.

46. ​​Hygienic assessment of noise and vibration on river vessels / T.T. Belogolovsky, V.A. Stakhova, A.M. Bokov // Hygiene and sanitation. -1994,- No. 3,- p.29-32.

47. Hygienic prevention: problems and solutions / N.F. Izmerov, M.M. Volgarev, T.I. Rumyantsev et al. // Bulletin of the Russian Academy of Medical Sciences. -1995. -No. 8. -p.37-40.

48. Hygienic aspects of using the resolution “On certification of workplaces for working conditions” / H.A. Mozzhukhina, D.P. Ho-lidlo, A.S. Not good, N.E. Karlin // Occupational medicine and industrial ecology. 1998.-№5.-s, 33-35.

49. Hyperbaric oxygenation in the complex of rehabilitation measures for sailors after a long voyage on sea vessels / V.V. Dovgut et al. // Physiological Journal. -1991. T.37, No. 6-p. 78-84.

50. Gobzhelyanov A.N. Adaptive reactions among fishermen on a voyage and measures for their correction // Medical and social aspects of the “Man-Ocean” problem - Vladivostok, 1988. 153.- 115

51. Gobzhelyanov A.N. Improving medical examination of sailing personnel (pre-nosological diagnostics, primary prevention): Dep. manuscript - Odessa, 1985. - p. 154.

52. Godin A.S. Study of the influence of noise on the auditory analyzer in various groups of sailors // UE International Symposium on Marine Medicine, September 23-30. M., 1976. 144.

53. Gozhenko A.I. Nutrition as the basis for the prevention and preservation of health of transport workers // Abstracts of reports of a thematic scientific and practical conference. Ilyichevsk 1992. -p.41.

54. Gorbonosova N.B. Functional shifts in ship radio operators // Proceedings of the International Symposium on Marine Medicine. -M., 1976. -p.42-44.

55. Gurin N.H. Optimization of medical care for sailors: Research report. -SPb., 1996. 45.

56. Davydov B.I., Tikhonchuk V.S., Antipov V. Biological action, standardization of protection from electromagnetic radiation // M.: Energoizdat, 1984. - p. 175.

57. Dantsych I.N. Hygienic assessment of artificial lighting on fishing vessels // Current state, prospects for the development of Marine medicine and hygiene of water transport: Materials of the All-Union Conference. M., 1983. p. 106.

58. Dynamics of mental and visual performance among high-speed fleet navigators / A.R. Snimoukhin, V.N. Doichun, A.G. Syromyatnikov et al. // VII International Symposium on Marine Medicine, September 23-30. M., 1976.-p.46.

59. Dmitriev M.G., Basolova JI.B., Shafran JI.M. Hygienic assessment of the sorption properties of synthetic materials used in shipbuilding and ship repair // Hygiene and Sanitation. 1983.-№10.-p.16-18.

60. Dolyatkovsky A., Dencha K. The influence of the ship’s working environment on the psychophysiological capacity of sailors // Proceedings of the Third International Symposium on Marine Medicine. -M.-1969. -p.27-32.

61. Dombrovsky A.Yu. Some organizational foundations of health-improving and preventive work on sea vessels // Healthcare of the Russian Federation. Federation. -1989.-№11.-e. 13-16.-116

62. Evstafiev V.N. Dynamics of physiological functions of the body of sailors in conditions of intensification of work activity If Human Physiology.-1990.-T.16, No.1.-p.140-155.

63. Evstafiev V.N. Physiological and hygienic aspects of work and rest of the crew // Medical and social aspects, problems of "Ocean Man". -Vladivostok, 1988.-p. 113.

64. Evstafiev V.N., Shafran J.I.M., Netudykhatka O.Yu. The performance of sailors under conditions of a changed work and rest regime // Military Medical Journal, - 1981.- No. 11.-p.47.

65. Morbidity among command crews / C.B. Naletov, P.Ya. Kravtsov, S.N. Shcherbakov et al. // Soviet healthcare. -1986. No. 11, - p. 33 -35.

66. Zaitseva V.N., Zavgorodniy A.E. The role of individual characteristics in predicting the functional state of ship operators on long voyages // Medical and social aspects, problems of “Man-Ocean”. Vladivostok, 1988.-p. 122-123.

67. Zayats T.A. Cardiorespiratory system in sailors during adaptation in Southern Primorye: Abstract of thesis. candidate med. Sci. Vladivostok, 1994.-20 p.

68. Zverev V.F. Features of the occurrence and course of neurotic reactions in ship specialists // Military Medical Journal. - 1971. - No. 11. - pp. 62-66.

69. Ivanov A.P. Reflexotherapeutic prevention of maladaptive reactions in sailors under voyage conditions // Medical and social aspects, problems "Ocean Man". Vladivostok, 1988.-p. 187.

70. Izmerov N.F., Denisov E.N., Molodkina N.N. Fundamentals of health risk management in occupational medicine // Occupational Medicine and Industrial Ecology. -1998. -No. 3. -With. 19.

71. Izmerov N.F., Kaptsov V.A., Pankova V.B. Basic principles of creating the service "Occupational Medicine" //" Occupational Hygiene and Occupational Diseases. - 1992. - No. 1. - pp. 1-3.

72. Izmerov N.F. Occupational medicine in the third millennium // Occupational medicine and industrial ecology. -1998. -No. 6. -p.4-9.

73. Izmerov N.F. Problems of occupational medicine in Russia: models of modern practice and strategy // Bulletin of the Russian Academy of Medical Sciences. - 1997, - No. 4. p. 3-7.

74. Kalyada T.V., Nikitina V.I. Cross-irradiation with microwave energy of ship crews in fishing conditions // Medical and social aspects, problems "Ocean Man". Vladivostok, 1988.-p.70-71.

75. Kanen V.V., Slutsker D.S., Shafran L.M. Human adaptation in extreme environmental conditions.-Riga: Zvaigznya, 1980.-184 p.

76. On the issue of prevention of diseases of the circulatory system in merchant marine sailors /" T.N. Vaskovatova, L.B. Kleiner, V.A. Lisobey, etc. // Abstracts of the thematic scientific and practical conference: Il-ichevsk, 1992 -p. 34.

77. Kirilyuk M.L. The role of acupuncture in the complex rehabilitation of sexual health of fishermen on a voyage // Med. rehabilitation, balneology and physiotherapy. -1998.-No.2.-p.61-62.

78. Kichkin V.I., Monakhov V.P. Medical examination as a control in improving the health of a sailor, river worker, fisherman // UE International Symposium on Marine Medicine, September 23-30. - M., 1976.-p.29.

79. Towards a comprehensive physiological and hygienic characteristics of the new work and rest regime for sailors / Yu.M. Stenko, D.S. Slutsker, L.M. Shafran, V.N. Evstafiev // Hygiene and sanitation.-1981.-No.1.-p.27-29.- 118

80. Kozlov I.I. Individual programming of motor activity as the main factor in the prevention of industrial physical inactivity // VII International Symposium on Marine Medicine, September 23-30. M., 1976.-p.34.

81. Konovalov Yu.V. Hygienic assessment of working conditions on certain types of fishing vessels and development of recommendations for their optimization // Medical and social aspects, problems "Man-Ocean" - Vladivostok, 198.-p.73-74.

82. Korovaev V.M., Novozhilov G.N. Motor activity and changes in physical performance in swimming // Military Medical Journal. -1972.-No.5.-p.64-66.

83. Korolkov V.F., Ishkildin M.I., Furgal S.M. Ways to improve immunoprophylaxis // Military Medical Journal. - 1990. - No. 10. - pp. 45-49.

84. Korotkoe Yu.A., Koshtymova L.N. Noise load and hemodynamics of sailors during the voyage//Hygiene and Sanitation.-1990.-No. 2,- p. 34-36.

85. Kosolapov A.B. Some methodological issues in studying the demographic status of sea workers // Problems of scientific research in the field of study and development of the World Ocean. Vladivostok, 1983. - p. 178-179.

86. Koshcheev V.S., Bobrov A.F., Shcheblanov V.Yu. The health of a working person and some approaches to its quantitative assessment // GRM.-1990. -№2.-r.7.-p.273.

87. Krasovsky V.O. Some generalizations of the experience of organizing certification of workplaces based on working conditions // Occupational Medicine and Industrial Ecology. -1998.-№3,- p. 25-30.

88. Krivelevich E.B. Methodological approaches to substantiating a system of dynamic monitoring of the health status of seafarers // Medical and social aspects of the “Man-Ocean” problem. Vladivostok, 1988.-p.35-36.

89. Krivelevich E.B. Social and hygienic aspects of marine medicine // Modern problems of marine medicine / ed. Yu.V. Kaminsky et al.: Vladivostok, 1991. 199-208.- 119

90. Krezhanovsky H.B. Chronic stress in maritime transport workers // VII International Symposium on Marine Medicine, September 23-30. -M., 1976.-p.40.

91. Kurpatov V.I., Yuryev T.P. Diagnosis of pre-morbid psychosomatic conditions of ship specialists // Military Medical Journal.-1995,- No. 3.-P.66-68.

92. Lebedev V.I., Nizhegorodtsev A.K. Some features of the work and life of fishermen engaged in tuna fishing in the tropical zone of the Pacific Ocean // Medical and social aspects of the “Man-Ocean” problem. Vladivostok, 1988. -p. 7 7.

93. Forester L.I. System of industrial and psychosomatic training in the transport fleet // Medical and social aspects of the “Man-Ocean” problem, Vladivostok, 1988, p. 132.

94. Lobastov V.M. Psychological foundations of navigation safety. -Vladivostok, 1980.-50 p.

95. Lobenko A.A., Psyadlo E.M., Demidova T.V., Relevance of psychophysiological occupational selection of sailors (literature review) // Occupational Medicine and Industrial Ecology. -2000.-№5.- p. 27-32.

96. Lobenko A.A., Kirilyuk M.L., Voitenko A.M. Dynamics of the health status of fishermen during a long autonomous voyage in the tropical zone of the Atlantic Ocean // Occupational Medicine and Industrial Ecology. -1997.-№1,-p. 45-48.

97. Lomov O.P. Current problems of hygiene of habitation of sea vessels // Medical and social aspects of the problem “Man-Ocean”. - Vladivostok, 1988. p. 58-59.

98. Lomov O.P. Hygienic principles of habitability of ships and vessels. -L.: Shipbuilding, 1989.-160 p.

99. Lomov O.P. Ship hygiene. St. Petersburg; M.: Medicine, 1993. - 206 p.

100. Lupachev V.V., Popov V.V. Dynamics of the psychophysiological state of fishing sailors during a long voyage // Human Physiology. -1997. -No. 5, - pp. 136-137.

101. Malysheva E.V., Zamotrinsky A.B., Malyshev I.Yu. The role of heat shock proteins in the formation of stress resistance // Bulletin. -expert biol. -1994.-No.7.-s. 11-13.

102. Malevich L.M., Vishnevsky A.M., Razletova A.B. Medical and technical problems of water transport hygiene // Occupational Medicine and Industrial Ecology. 1999. - No. 12. - p.4-9.

103. Matsevich L.M. Tasks of ship hygiene in modern conditions // Medical and social aspects of the “Man-Ocean” problem. Vladivostok, 1988.-p. 33-34.-120

104. Matsevich L.M., Kaminsky Yu.V., Sharonov A.S. Marine medicine. Paths of development // Modern problems of marine medicine / ed. Yu.V. Kaminsky et al.: Vladivostok, 1991. 9-19.

105. Matsevich L.M. Marine hygiene // Modern problems of marine medicine / ed. Yu.V. Kaminsky et al.: Vladivostok, 1991, - Chapter 2 p. 19-62.

106. Matsevich L.M., Fillipov V.A. Rehabilitation system for sailors // Modern problems of marine medicine / ed. Yu.V. Kaminsky et al.: Vladivostok, 1991- p. 180-188.

107. Matsevich L.M. Human factor and safety of navigation // Medical and social aspects of the “Man-Ocean” problem. Vladivostok, 1988. 108-109.

108. International Guide to Ship Medicine. -2nd ed. -Per.M. WHO, 1992. -446 p.

109. Menshov L.A. The influence of industrial vibration and noise on the human body. Kyiv: Health, 1997, - 126 p.

110. Minko V.M. Optimal management for improving working conditions in fisheries // Fisheries. 1986. -№11. -p.18-21

111. Mikhailyuk A.M., Golubyatnikov N.I., Kozlovsky S.N. Sanitary and hygienic assessment of working conditions of the RPB "Vostok" // Abstracts of reports of a thematic scientific and practical conference. -Ilyichevsk, 1992. -p. 113114.

112. Mishkich I.A. Hygienic assessment of the air in the working area when cleaning ship electrical equipment with washing liquids // Medical and social aspects of the “Man-Ocean” problem. Vladivostok, 1988.-p.79.

113. Molodkina I.I. The problem of professional risk. Assessment and social protection // Occupational Medicine and Industrial Ecology. 1998, - No. 6. - pp. 41-48.

114. Monakhov V.P., Radzevich A.E. Occupational characteristics of morbidity among seafarers // VU International Symposium on Marine Medicine, September 23-30. M., 1976. 16.

115. Myznikov I.L. Information model of adaptation development // Human Physiology. -1995.-T.21, No. 4. -With. 63-68.

116. Myznikov I.L. Assessment of the adaptive behavior of the body according to hemodynamic parameters // Hygiene and Sanitation. -1993. -No. 1.-s. 62-63.

117. Naletov S.B., Lebed I.A. Electrocardiogram measurements in ship operators //Medical business. -1983. -No. 3. -With. 105-106.

118. Adverse factors during the processing of krill on ships and prevention of their effects on the body of seafarers / P.C. Potronova, V.I. Odintsova, V.I. Bashcheva, V.V. Baronin // Medical and social aspects of the “Man-Ocean” problem. Vladivostok, 1988.-p.91.- 121

119. Neustadt Ya.E., Matsevich JI.M. Regime and working conditions on sea and transport ships // Proceedings of the III International Symposium on Marine Medicine. M.-1969. -With. 24-27.

120. Neustadt YAZ. Physiological and hygienic foundations of the scientific organization of labor in the navy // Proceedings of the P1 International Symposium on Marine Medicine, M.-1969. -With. 8-13.

121. Netudykhatka O.Yu. Incidence of seafarers with congenital ulcers // Hygiene and sanitation. -1993. -No. 10.-s. 48-50.

122. Netudykhatka O.Yu. The importance of psychophysiological characteristics of sailors in the occurrence of injuries // Orthopedics, traumatology. -1987. -No. 7. -With. 51-52.

123. Netudykhatka O.Yu. On assessing the labor intensity of sailors of different ages // Medical and social aspects of the “Man-Ocean” problem. Vladivostok, 1988.-p. 134.

124. Netudykhatka O.Yu. Peculiarities of morbidity among seafarers // Occupational Hygiene and Prof. diseases.-1989.-No.5.-p.16-18.

125. Netudykhatka O.Yu. The role of the critical frequency of flicker fusion in assessing the work intensity of sailors // Ophthalmol. magazine. -1987.-No. 5,-p.300-303.

126. Netudykhatka O.Yu. Modern problems of seafarers’ labor intensity: Literature review // Journal of Urn. hygiene, epidemiology, microbiology and immunology. -1990.-T.34, No. 3.-p.289-297.

127. Novikov B.S. The problem of diagnosing pre-nosological conditions in marine medicine // Man and ship 2000. -M., 1986. -p.376-378.

128. Novikov V.S., Mastryukov A.A., Petrov V.P. Prevention of vitamin C deficiency among ship specialists // Hygiene and Sanitation. -1984. -No. 6.-p.85-87.

129. Novikov B.S. Ways and methods of managing the adaptation process and resistance of the sailors’ body // Military Medical Journal. - 1985. - No. 9. - pp. 54-56.

130. Novikova S.S., Basalaeva L.V. Ways to improve the hygienic properties of vibration-absorbing materials of modern sea vessels // Medical and social aspects of the “Man-Ocean” problem.-Vladivostok, 1988.-p.84.

131. Features of diagnosis and treatment of damage to the musculoskeletal system in sailors / Lobenko A.A., Ponyatovsky Yu.V., Kostrolin P.S. and others // Medical and social aspects of the “Man-Ocean” problem. Vladivostok, 1988.-p.229.-122

132. Features of body functions and risk factors among sailors of Southern Primorye / V.V. Berdyshev, H.A. Sukhacheva, T.F. Grigorenko et al.//Medical and social aspects of the “Man-Ocean” problem. Vladivostok, 1988,-P.113.

133. Assessment of working conditions for crew members exposed to electromagnetic radiation on river vessels / T.G. Belogolovsky, V.A. Stakhova, A.I. Bokov and others // Hygiene and sanitation. -1994. -№2.-p.33-34.

134. Assessment of the functional systems of the body based on the indicators of its nonspecific reactions / A.B. Zakharov, M.P. Moroz, V.I. Primakov and others // Military medical journal.-1992.-No.9.-p.45-47.

135. Petrenko B.E., Kutilev N.V. On the diagnosis of the subclinical stage of vibration disease//Hygiene and prof. diseases. -1983.-No.2.-p.47-49.

136. Petrov V.A. Nutrition problems and the Ocean // Modern problems of marine medicine. Vladivostok, 1991. - Chapter 3, - pp. 63-90.

137. Pigolkin Yu.I., Volodin S.A. Fatal damage by sea vessels // Medical and social aspects of the “Man-Ocean” problem. Vla-divosto^^Z.-s^b.

138. Pisarenko E.F., Timofeev V.N. The influence of environmentally unfavorable factors of the ship's environment on the body of sailors // Human Ecology. -1997.-No.3.-p.20-23.

139. Piskunov M.I., Bloshchinsky I.A. The use of gymnastic exercises to improve the performance of sailors in swimming // Military medical journal. - 1986. - No. 4. - p. 42.

140. Plokhov I.N., Tepina JI.T. The influence of microclimate on the adaptation of sailors when sailing in low latitudes // Military Medical Journal. - 1988, - No. 5. - pp. 51-53.

141. Pogorelov I.A., Shimanovich E.T. On the physiological mechanisms of autogenic training and its application in sailors during long voyages // Military Medical Journal. - 1988. - No. 7. -p.57-58.

142. Pogorelov Ya.F. Socio-demographic interdependence of health and development of the population of the Russian Federation and ways to improve it. M., 1994.-p.65.

143. Podovinnikov G.M. The influence of post-move rest on the cardiovascular system of sailors // Military Medical Journal. - 1980. - No. 9, - pp. 57-58.

144. Pomozin O.S. On the issue of preventing hypokenesia in the fleet // UP International Symposium on Marine Medicine, September 23-30, Odessa-M., 1976. 148.

145. Ponomarchuk B.S. Vegeto-ophthalmological aspects of the professionography of seamen of transport and industrial ships // Ophthalmol. journal - 1983. - No. 5. - pp. 265-269. - 123

146. Ponomarchuk V.S., Voloshin M.K. Absolute light sensitivity of the visual analyzer in sailors during a ten-month industrial voyage // Ophthalmol. journal - 1989. - No. 2. - pp. 107-110

147. Problems of the development of maritime transport in the Far East: Abstracts of the interuniversity scientific and technical conference on May 14-16, 1997, part 1 / Ed. count S.L. Ogai et al. - Vladivostok: DVGMA, 1997. -105 p.

148. Industrial noise/S.V. Alekseev, M.L. Khaimovich, E.I. Kadyski-na, G.A. Suvorov. -L.: Medicine, 1991.-132 p.

149. Prevention of mental disorders among maritime workers / N.D. Belokobylsky, I.T. Ulyanov, L.P. Yatskov et al. // Health of the population of the Far East, - 1996. - Vladivostok, - pp. 169-170.

150. Prokhvatilov I.A. About the work and rest regime of fishermen // Pisces. farm.lvov. 1,-s.eo-eb.

151. Psychotherapy of functional disorders in sailors after prolonged work in extreme conditions / P.P. Kalinsky et al. // Bulletin of typology and psychiatry. -I99l.-№l.-c 35-36.

152. Rozomat Yu.M. Hygienic characteristics of noise on sea vessels // Proceedings of the III International Symposium on Marine Medicine, - M.-1969. -With. 50-53.

153. Regulation of physical factors. Results and prospects / G.A. Suvorov, R.F. Afanasyeva, Yu.P. Paltsev, L.V. Prokopenko // Occupational medicine and industrial ecology. 1998, -№6. - p.26-34.

154. Rogalev K.K., Slutsky M.I. Assessment of the functional state of the body of sailors on Arctic voyages // Hygiene and Sanitation. -1992.-No. 2,-s.I-13.

155. Sannikov A.L., Lunachev V.V., Popov V.V. Psycho-correctional and medical-social work among Russian sailors in conditions of long-term sea fishing // West, psychosocial and correctional-rehabilitation work. -1998. -No. 2. -With. 32-3 5.

156. Sapov I.A., Kulikov V.I. Sea sickness and performance of the crew of a surface ship // Military Medical Journal.-1975.-No. 4.-p.88-91.

157. Sapov I.A., Novikov V.S. Nonspecific mechanisms of human adaptation. -L.: Nauka, 1984. 146 p.

158. Sapov I.A., Smorodin N.F. The influence of air noise on the human cardiovascular system // Military Medical Journal.-1970.-No. 6.-p.80-82.

159. Sapov I.A., Solodkov A.S. State of body functions and performance of sailors.-L.: Medicine, 1980.-192 p.

160. Svidersky V.P. Protecting the health of Far Eastern fishermen // Sov. healthcare. -1987.-No.3.-p.26-28.-124

161. Semenov S.B., Spitsyn S.A. On improving the organization of state sanitary supervision of ships // Hygiene and Sanitation. -1990.-№6.-p.82-83.

162. Sergeev E.P., Matsevich L.M., Rezina Yu.I. Modern problems of occupational hygiene of seafarers and some ways to solve them when sailing in the Arctic // Hygiene and Sanitation. -1973.-№7.-s. 12-16.

163. Serov V.V., Tomilina I.V., Sudakov K.V. Morphofunctional characteristics of connective tissue during emotional stress // Bulletin. exp. biol. -1995.-No.6.-p.571-573.

164. Serykh T.A., Yurkovsky A.D., Belyaev A.F. On the peculiarities of skin pathology among sailors of the Far Eastern region // Abstracts of reports of a thematic scientific-practical conference. Ilyichevsk, 1992. 152-153.

165. S Krupkiy V. A. The influence of pitching on the sleep of the crew and Shipbuilding. -1987.-No.4.-p.12-13.

166. Slutsker D.S., Balakirev E.M. The role of the ship's doctor in reducing the incidence of seafarers // Proceedings of the III International Symposium on Marine Medicine. M.-1969. -With. 176-179.

167. Modern ideas about adaptation in the light of the teachings of N.V. Lazareva / T.I. Sidorin, A.D. Frolova, M.P. Chekunova and others//Toxicological Bulletin.-1995.-No.5.-p.20-26.

168. Modern problems of marine medicine / Ed. Yu.V. Kaminsky, L.M. Matsevich, A.A. Yakovleva. Vladivostok: Far Eastern University Publishing House, 1991. -268 p.

170. Sokolov M.O. Development and implementation of an automated system “Certification of workplaces based on indicators of harmful and dangerous factors”: Report of the research work of TsNIIMF on naval vessels.-M., 1996.-32 p.

171. Solodkov A.S. Adaptation and physiological reserves of the sailors’ body // Military medical journal. - 1980. - No. 10. - p. 56-58.

172. The state of health of fishermen in the dynamics of inter-trip rest and criteria for its assessment/M.L. Kirilyuk, S.G. Artyunov, V.A. Zhukov and others // Abstracts of reports of a thematic scientific-practical conference. - Ilyichevsk, 1992. - p.82.

173. Health status of icebreaker crew members/V.M. Baranova, L.V. Oparina, N.V. Bulygina and others//Occupational Hygiene.-1991,-No. 4.-p.4-6.

174. Directory of the ship's doctor/A.A. Lobenko, L.I. Aleynikova, E.A. Vos-novich and others//Kyiv: Health, 1984, - 278 pp. - 125

175. Starozhuk I.A. Occupational medicine during work using general vibrations and preventive measures: Dis. Doctor of Biology Sci. M., 1996. -669 p.

176. Steimatsky A.R. The influence of monotony on the performance of navigators // UP International Symposium on Marine Medicine, September 23-30. Odessa M., 1976.-p.59.

177. Stenko Yu.M., Varenikov L.I. Prevention of the phenomena of cumulation of fatigue in sailors on long voyages using the electrical sleep method / Occupational Hygiene and Prof. diseases.-1985.-No.5.-p.42-44.

178. Stenko Yu.M., Vinogradov S.V., Filatov T.A. The influence of a complex of climatic and ship factors on the state of psychophysiological functions of sailors of the Arctic fleet // Occupational Hygiene and prof. diseases.-1985.-No.5.-p.42-44.

179. Stenko Yu.M., Psychohygiene of a sailor. -L.: Medicine, 1981.-176 p.

180. Stenko Yu.M., Tkochenko V.D. Social and psychological features of a fisherman’s stay on a long voyage // VII International Symposium on Marine Medicine, September 23-30, Moscow, 1976.-p.60.

181. Stepanova S.I. Biorhythmic aspects of the problem of adaptation. -M.: Science. -244 s.

182. Strakhov A.P. Adaptation of sailors on long ocean voyages -L.: Medicine, 1976. -127 p.

183. Sudakov K.V. Neurochemical nature of “stagnant” excitation in the structures of the sea during emotional stress // Pat. physiology. -1995.-No.G-s.Z-8.

184. Suvorov G.A., Prokopenko L.V., Yakimova L.D. Noise and health. M.: B.I., 1996.-150 p.

185. Suvorov G.A., Shkarinov L.N., Lenisov E.I. Hygienic regulation of industrial noise and vibration.-M.: Medicine, 1984.-240 p.

186. Timokhov S.A. Injuries on sea vessels, Arkhangelsk, 1974.-360 p.

187. Tomescu K. Social and hygienic problems among sailors// VII International Symposium on Marine Medicine, September 23-30 - M., 1976.-pp.62-63.

188. Physiological justification of permissible noise levels during heavy physical and nervously stressful work / G.S. Zvereva, M.V. Ratier, A.B. Kolchanova et al. // Occupational Hygiene and Prof. diseases.-1982.-No.7.-p.7-11.

189. Physiology of human movements and shift work/V.A. Matyukhin, S.G. Krivoshchekov, D.V. Demin//Novosibirsk: Science, 1986.-197 p.

190. Khasina E.I. The main experimental results of the use of Eleutherococcus extract for physical inactivity // Medical and social aspects of the problem “Ocean Man”. Vladivostok, 988.-p.300-301.

191. Tsaneva JI. Dingikova S. Comparative assessment of methods for studying the influence of industrial noise in modern forms of labor //Hygiene and Sanitation.-1995.-No.3.-p.45-46.

192. Shamin S.A., Denisov E.I., Ovokimov V.G. Experimental study of the nature of the dose dependence of the influence of general vibrations // Hygiene and Sanitation. - 1987. - No. 1. - p. 9-12.

193. Shapovalov K.A. The fight against injuries in water transport // Kazan Medical Journal. - 1989. - No. 5. - p. 370-371.

194. Shapovalov K.A. Multiple injuries in sailors on ships/Orthopedics, traumatology and prosthetics.-1988.-No. 12.-p.44-46.

195. Shapovalov K.A. Peculiarities of injuries among water transport personnel // Healthcare of the Russian Federation. Federation.-1991.-No.8.-p.11-13.

196. Shatalov A.I., Myznikov I.A., Obaturov A.A. Functional status of sailors of various professional groups // Military medical journal. - 1995. - No. 6. - p. 61-64.

197. Shafran L.M. Adaptive reserves of the body and predicting the reliability of the activities of ship specialists // Medical and social aspects of the “Man-Ocean” problem. Vladivostok, 1988.-p.52-53.

198. Shafran L.M., Zavgorodniy A.E., Belobrov E.P. Psychohygienic prevention and correction of functional disorders in workers working in conditions of increased chemical danger // Medical Affairs, - 1990, - No. 3. - pp. 106-108.

199. Shimanovich E.G. On the peculiarities of sleep regulation by physical exercises performed at a certain time of day // Occupational Hygiene and Prof. diseases.-1989.-No.10.-p.39-40.

200. Noise and vibration on sea, river and fishing vessels/I.I. Varenikov, A.A. Volkov, A.Ya. Gerasimov and others // UP International Symposium on Marine Medicine September 23-30, 1976, Odessa M., 1976, p. 113.

201. Shumilov G.D. Comprehensive social and hygienic study of the health of fishing fleet sailors and their families // Medical and social problems of health protection at the stage of transition to insurance medicine. Conference materials St. Petersburg, 1992.-P.46-47.

202. Shchepin Yu.V., Koldaev V.M. Electromagnetic radiation and morbidity on sea vessels and coastal facilities in Primorye // Health of the population of the Far East.-Vladivostok, 1996, p. 24-25.

203. Eismont V., Kanevsky E. Work and rest regime on sea, fishing and river vessels // Proceedings of the Third International Symposium on Marine Medicine.-M. 1969. -p. 13-22.- 127

204. The effectiveness of the use of biologically active substances to increase the resistance of the body of sailors/V.S. Novikov, V.N. Bortnovsky, A.A. Mastryukov and others//Military medical journal.-1987.-No. 10-p.50-51.

205. Yaneva S., Tocheva T. Results of a study of the cardiovascular system of sailors of the BMF shipping company 7/ Abstracts of reports of a thematic scientific and practical conference. - Ilyichevsk, 1992. 192-193.

206. Beiastung una Beanspnuchung des nautisehen Personals (lurch rnehrnionaioge konstante wasch-systems bei schisssjuhran ernes ol Jpobtakers/ F. Kliumer, P. Knauth, B. Neidhort u.a.// Arbeissmed. Sozialmed.-1984.- Bd. 19 - h.z. -s 161166.

207. Beneitz Diego C., Taunz Marhuenda C. // Medic. Marit. 1996. - Vol. 1, No. 3. - P. 16-25.

208. Bovenzi M. Cardiovascular responses stimuli in workers with vibration-induced white finger // Europ. j. appl. Physical.-1989.- vol.59.-#3.-p. 199-208.

209. Britaniko T.R., Lazo A.Z., Bandalan D.P. // In: 4th Int. Symp. On Maritime Health. Turku, Finland, 1991.

210. Caver O.H., He 1996ny J.P. Bekn C. The pegulation of extracenvlan fluid volium // Am.Rev. Physical. -1970.-vol.32 p.547-595.

211. Jaremin V., Kotulak E., Starnawska M., Tomaszunas S. // J. Travel Med. -1996. -No.3.-P.91-95.

212. Marine Medical Research Collection //Extracts from Japanese. J. Marit. Med., 1995. - 744 p.

213. Prieser C. // In: Witting W. Abstracts Papaers / Posters Submitted for Review by the Int. Papers Selection Committee. ISHFOB, 1995. - P. 39.

214. Quillis Figueroa L., Burgos Ojeda A., Poleo Mora A.J., Garcia Melon E. // Med. Marit. 1996. - Vol. 1, No. 3. - P.37-41.

215. Robinerre C.D., Silverman C., Gabbon S. Effect upon health of occupational exposure to microwave radiation //Amer. J. Epidemiology.-1980. Vol.l9.-№5.-p.440-457.- 128

216. Rothblum A.M., Carvalais A.B. I I In: Handbook of Human factors testing and evaluations / O" Bnen, Thomas G. (Ed). 1996. - P.287-300.

217. Shafran L. //Witting W. Abstr. of Papaers / Posters Submitted for Review by the Int. Papers Selection Committee. ISHFOB, 1995. - P. 49.

218. Scheider H., Wall H. Psychisch Wirkunslu langreitogen berslicher Conzkonpervibration // Z. ges. Hys. -1989 -Bd. 35, H.h. s.206-208.