Vol 96, No 4 (2017)

By means of transformations based on the scientific and educational basis of the two higher education institutions with more than 100 years of history, pursues the policy of best traditions of the outstanding medical schools. In the I.I. Mechnikov North-Western State Medical University the special attention is paid to the training of qualified personnel for a wide range of health care organizations and the health care system of state sanitary and epidemiological surveillance, which is reflected in the university’s Mission. In the I.I. Mechnikov North-Western State Medical University there was developed a complex of innovative technologies, which seem for the first time in Russia to implement a systematic approach to the practice-oriented training in modern molecular techniques in medical microbiology and epidemiology. For the first time in world practice, there was developed and introduced in the training simulator training in microbiology based on software complex automated laboratory. At the beginning of the 21st century I.I. Mechnikov North-Western State Medical University determines its future strategy on the formation of doctors, along with professional competences, motivation to health-saving lifestyle that will ultimately contribute to the improvement of the quality of life of the all population

Purpose of the study. The study of actual nutrition and nutritional status of patients with metabolic syndrome and intestinal dysbiosis under outpatient observation for subsequent correction of nutrition. Material and methods. The actual nutrition in conditions of outpatient observation was studied in 117 patients (60 men and 57 women) aged of 18-60 years, living under the service of the one of the clinics of St. Petersburg. In these patients on the basis of results of clinical and laboratory-instrumental examinations there was revealed metabolic syndrome, but on the basis of the microbiological examination of feces there was established intestinal dysbiosis of the 1-2 grades. The nutrition was studied by means of questionnaire-ballot method, and with the use of computer software «Analysis of the state of Human Nutrition» (version by Institute of Nutrition, 1.2.4. - 2003-2006). Daily energy expenditures were calculated according to table-time-keeping method. Body composition of patients was studied by impedance method with the use of diagnostic monitoring complex «Diamant». All patients were included in the study on the base of the principle of informed consent and all of them gave written consent. Results. The caloric content of the daily average diets of patients with metabolic syndrome and intestinal dysbiosis exceeds in an average the physiological norm by 930 calories. Nutrient composition of diets of men and women have the same features: in compared with the daily requirement there was excessive content of fat, NLC, cholesterol, protein, sodium, phosphorus deficiency of dietary fiber, vitamins A and B2, magnesium, starch. Conclusion. The structure of food packages, caloric content and nutrient composition of the diet of patients with metabolic syndrome and intestinal dysbiosis seem to be unbalanced and cannot serve to purposes of the prevention and treatment of this disease. The characteristic imbalance of the body components in these patients was the excess of fat mass and total fluid.

Introduction the aim of the study. The implementation of risk-oriented model organization of the control and supervision activities of Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing with the assessment system of potential dangerous objects requires the creation of multiannual reliable database about the occupational working conditions which must include results of the production control for enterprises of all industries of the national economics of the Russian Federation. The aim of the study was to study the effectiveness of the use of the production control (PC) results of working conditions for the provision of sanitary - epidemiological wellbeing of the population. Material and methods. The study was conducted on materials of Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing on the Leningrad region, Petrostat for 2009-2012. In analysis there were included software and PC results of working conditions in 420 industrial enterprises of various branches of the Leningrad region industry. To develop a regional model of PC program planning based on critical control points there was chosen the major refinery in the Leningrad region - Limited Liability Company “Production Association” Kirishinefteorgsintez “(LLC “PA “KINEF”). 3960 protocols of laboratory and instrumental investigation results of working conditions were made for the purpose of PC control on LLC “PA “Kinef” and 1921 protocols of PC results - on 420 industrial enterprises of the Leningrad region were analyzed. Results. The performed analysis revealed a number of problems to the application of PC results for the aim of working conditions optimization of employees, planning disease prevention program and the assessment of object’s sanitary-hygienic wellbeing. The method of critical control points (CCPs) in the planning of PC programs on the large industrial enterprises is proposed to use. On the example of “Kinef” there was shown the efficiency of the use of CCPs in order to optimize the PC programs. There was developed and implemented the regional model of the use of PC programs which allows to solve the problem of the significant increase of preventive orientation and efficiency of PC program at enterprises of all sectors of the national economy of the Russian Federation as an important element of the management of sanitary - epidemiological population wellbeing regarding to the maintenance of healthy and safe working conditions. Conclusions. Existing legal regulatory and methodological framework regulating the organization and performance of PC control and social - hygienic monitoring in the Russian Federation requires significant changes and additions what allow to increase the reliability of the objects classification on groups of sanitary-epidemiological wellbeing and to realize a risk-oriented approach to control and oversight activities.

The purpose of the study is to provide toxicological-hygienic assessment of components the production of polyvinyl chloride, substantiate safe levels of chemicals in air of the working area and preventive measures on optimization conditions both of work and residence of the population. Material and methods. The object of the study was the complex of production of polyvinyl chloride (PVC). The program of research included the study of the technological process; evaluation of the toxicity and dangers of new chemicals; the characteristic of sources of air emissions; health risk assessment of the population; justification of the size sanitary-protective zone. Results. The enterprise for the production of PVC can be potential source of the environmental pollution, with the priority to pollution of the atmosphere and working area air. The main organized emission sources of the chemicals are departments for the production of chlorine, vinyl chloride monomer, polyvinyl chloride and flare units. New components of production are ntioxidant IRGASTAB PVC76 and plasticizer Plastomoll DOA on physic-chemical and toxic characteristics fail to pose a risk of acute and chronic poisoning by inhalation routes of exposure, the parameters of acute toxicity refer to the 4th class of danger and seem to be low-hazard substances. Antioxidant IRGASTAB PVC 76 under repeated applications leads to mild irritation of the skin, characterized by a slightly pronounced cumulative properties, in contact with a high likelihood of sensitization of the organism; the introduction inhibits the activity of cytochrome P-450-dependent that may result in the violation of the detoxifying function of the liver. Antioxidant IRGASTAB PVC 76 under repeated applications leads to a slight irritation of the skin, characterized by mild cumulative properties, contact likely to develop sensitization of the organism; upon administration inhibits the activity of cytochrome P-450-dependent MOG that might lead to a violation of the detoxifying liver function. Emissions to the atmosphere can contain up to 50 polluting chemicals. The main contribution to emissions comprises substances of the 3 and 4 hazard class, it is related with extremely dangerous and highly dangerous chemicals up to 32% of the total list of toxic substances. Indices of non-cancer risk with or without accounting background are at an acceptable level, the probability of the carcinogenic risk is small. There is a possibility risk of developing obsessive smell of nitrogen dioxide, sulfur dioxide, chlorethene and chloroform.

Introduction. The problem of preservation of the health of drivers is a topical for most of countries. In the process of working, the mentioned group is exposed to a complex of harmful occupational factors, that both leads to an elevated increased risk for health disorders and increases the risk of road accidents. However, in available sources it was not possible to reveal reports devoted to the study of the impact of the labor conditions of drivers on various health indices on the base of the methodology of occupational risk assessment. The aim of the study is to assess the occupational risk for drivers of specialized vehicles on the basis of indices of pathological affection, calculated on the results of periodic medical examinations. Material and Methods. As a core group there were selected truck drivers (n = 1050), as a comparison group - engineering and technical personnel of the enterprise (n = 1220), matched by age and social indices. The assessment of the occupational morbidity rate was carried out on the base of the analysis of fourfold tables with the use of c2 criteria. The assessment of the degree of the occupational dependence was executed with the calculation of risk indices in accordance with the Guidelines for Risk Assessment. Results. In the course of the study there were obtained results showing drivers to suffer most frequently from diseases of eyes (65.4%), circulatory system (46.6%) and digestive system (11.6%). The main reason for the recognition of drivers as unfit to drive vehicles is hypertension at the II stage and above (71.1%). Also, there is noted an increased occupational risk in drivers for such diseases such as hypertension at the I stage (RR=2.2, CI95%=1.8-2.8, EF=54.5%, a high degree of the relationship with the work); encephalopathy of the vascular genesis (RR = 1.6, CI95%=1.1-2.4, EF = 37.5%), moderate degree of the relationship with the work in the age of older 60 years - is very high); dorsopathies at the lumbosacral level (RR=2.9, CI95%=1.6-5.3, EF=65.7%), a high degree of the relationship with the work at the age of over 50 is almost total); sensorineural hearing loss (RR=1.2, CI95%=0.7-2.0, EF=16.4%), a low degree of the relationship with the work over the age of older 60 years - moderate); hyperopia (RR=2.1, CI95%=1.7-2.5, EF=52.4%, a high degree of the relationship with the work), which determines the priority of preventive measures in relation to these diseases. The potential effect of the preventive measures is most pronounced for the circulatory system diseases in total (NNT = 13.6) and hypertensive disease at the I stage (NNT = 10.0).

The relationship between hygienic conditions of labor, health state and personal psychosocial characteristics of medical staff today proves to be the urgent problem. A specifics of the work of pediatric dentists is related to the impact of unfavorable environment factors on their bodies and the presence of the high psychophysiological load under working with children. It is interesting to study the features of the contemporary labor process to improve preventive measures aimed at optimizing the operation of children’s dentists.

Introduction. One of the key factors influencing on the quality of drinking water is the high level of water sources of the pollution, leading to the need for large-scale water treatment. There are remained risks, the consequence of which may lead to the deterioration of the quality of drinking water which is conveyed to the population. It is necessary to introduce effective technologies of water treatment, informative and reliable approaches for the assessment of epidemiological safety and harmlessness of drinking water. One of the priority directions is the development and use of methods of the integral assessment of drinking water quality. Aim of the study. For this purpose there was developed a method for the integral assessment of drinking water relying upon indices of the chemical harmlessness and a method for the comprehensive assessment of the risk of bacterial intestinal infections transmitted by water. There is proposed a method of assessing the quality of drinking water in terms of epidemiological safety, based on the fundamental principles, and providing a probabilistic approach to the assessment of health risk. Conclusion. The development, argumentation and implementation of the method of the integral assessment of the probabilistic health risk with the combined effect of chemical and microbiological agents contained in drinking water remain to be actual.

The purpose of the study is to make a comprehensive ecological and hygienic assessment of production waste - ferromanganese nodules of the Baltic sea and ash from sewage sludge for compliance with the use as road material. Material and methods. The study was executed in accordance with the applicable guidelines. Results. Waste production of Manganese - Ferruginous Sands, and ash from the incineration of sewage sludge in the city of St. Petersburg represent complex multicomponent mixtures of substances with different percentage content of metals (manganese, iron, silicon, phosphorus, aluminum, cadmium) and their compounds which seem to be low-hazard wastes (IV class of danger) to the natural environment.

Modern socially-oriented policy in Russia prioritizes the complex of prevention activities with the use of modern health-saving technologies. At that it is necessary to substantiate methodologically and methodically integrated quantitative and qualitative characteristics, based on which evaluation of the types of functioning and conditions of life affecting health and quality of human life is possible. On the basis of specially developed complex program (15 scales) the study of the quality of life and health of the urban working population of St. Petersburg (n=2276) was executed. The method of the determination of the risk groups according to types of functioning and health groups was developed. Performed medico-social and clinical-statistical study allowed to identify changes of the quality of life indices according to the type of functioning at various conditions and characteristics of life and health. According to indices of the quality of life there was revealed the high proportion of urban residents in groups of relative and absolute risk. Especially significant decrease in the quality of life indices in these groups was noted on indices of socio-hygienic functioning, socio-economic well-being, socio-psychological comfort, social adaptation, recreational activities, medico-social activity and prevention activities. There was established a higher probability of the formation of chronic disease and the decrease in the satisfaction with the quality of life in urban residents in groups of the absolute risk with dissatisfaction with the living conditions and livelihoods. The proposed scales and types of functioning in the structure of health-related quality of life can be used in a comprehensive hygienic studies implemented on the basis of a risk assessment methodology, under comparison of indices of livelihoods and satisfaction with living conditions, in complex evaluation of the efficiency of medical preventive, social and environmental programs

The existing classifier of qualifications appears to be replaced by professional standards (PS) for specialists of preventive medicine, approved by the order of the Ministry of labor of RF № 399n from 25.06.2015. This is a multifunctional regulatory document setting requirements for the content, quality and conditions of the work, qualifications and competencies, professional education and training for skills required to meet this qualification, as well as a description of the ethical standards that are obligatory for the acceptance and respect of all members of the professional community. The standard includes the main type of professional activity of specialists of preventive medicine direction - ensuring sanitary and epidemiological welfare of the population and protection of consumers, identifies summarized working functions and corresponding qualification levels for the specialist, as well as requirements for education and practical activities which are necessary for their implementation. For the each working function included into the standard there are identified required knowledge and skills. The Federal educational-methodical Association in the field of the science of health and preventive medicine prepared a new educational standard in which the professional tasks and competences of the future specialist were both harmonized with the labor functions described in the standard and aligned with the major employer of graduates - Federal Service on Surveillance for Consumer rights protection and human well-being. Conclusion. The implementation of the professional standard provides a number of advantages for specialists of preventive medicine, its employers and professors of universities. Continuous updating of professional standards will allow to assess the quality and level of employee competencies, mainstream vocational training programs at all levels, aimed at creating and improving the professionalism of preventive medicine direction.

Diseases of the musculoskeletal system are the most common pathologies of the modern society, yielding frequency only to diseases of respiratory and cardiovascular systems. Given the fact that they are occurred in a young, working-age population, as well as people in older age groups, the treatment of these patients consumed large financial resources, which results in a high socio-economic importance of rheumatic diseases in general. The article focuses on the prevalence of these forms of pathology in Russia and several foreign countries, material costs of the medical care of such patients (including direct, indirect and additional costs), the change of these ratios in connection with the increased longevity of the population, and the emergence of new high-tech methods of treatment, which led in some cases to a significant rise in the cost of medical services. There are discussed measures to optimize the treatment of these pathologies based on pharmaco-economic aspects.

The research includes the assessment of the lifestyle factors of the major players of the educational process (students and teachers) in the modern medical school, the analysis of sources of knowledge on a healthy lifestyle and preventive measures, the awareness of a healthy lifestyle; the development and testing of new educational programs for training students and teachers, developing tactics on improving medical education to meet practical needs of the network of health care facilities and institutions of the Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor). Medical and sociological studies of lifestyle factors of students showed 62.9% of respondents to have insufficient sleep duration. Lack of exercise is the second most frequent factor(51.7%). 31.1% of students noted disturbances of the dietary pattern. 20.0% of the surveyed students were cigarette smokers. 12.7% of students regularly gambled mostly with the use a computer. 2.8% of respondents admitted that they regularly used drugs and 1.7 % of respondents drank alcohol every day. The data obtained show the lifestyle of a substantial proportion of the future doctors to be failed to be considered healthy. Analysis of the sources of students’ knowledge on a healthy lifestyle shows 59.9% of them to gain knowledge in the process of becoming a doctor, 42.7% - from specialized professional literature. However, a substantial proportion of the students receive the information about the preventive health care measures from the nonprofessional sources. For the improvement of the educational process and preservation of health of major players we consider a comprehensive interdisciplinary program that includes specialized courses for the first and fifth year students, advanced training sessions for teachers and the consolidated program on preventive health care and health promotion in all disciplines of undergraduate training to be necessary.

This article covers the aspect of food safety provision by product chain participants under current conditions by means of the development of food safety management systems (FSMS) based on НАССР (Hazard Analysis and Critical Control Points) principles. НАССР principles and logical approach for setting and solving specific tasks, preceding HACCP principles, are discussed. The main stages of food safety management system development and implementation are presented, as well as advantages from its implementation.