Kronična opstruktivna plućna bolest i red: retrospektiva istraživanja provedenog na kohorti industrijskih radnika

The aim of this paper was to ascertain chronic obstructive pulmonary disease (COPD) prevalence among industrial workers in the Russian Federation and determine relative contribution of smoking and occupational factors to COPD. We recruited 1,375 workers aged 30 or over. Six hundred and twenty-four of them were occupationally exposed to vapours, gases, dust, and fumes (VGDF). Physical examination and baseline spirometry were performed for all the participants of the study. Those with airfl ow limitation of FEV1/FVC<0.70 were considered having COPD and those with presence of cough and sputum production for at least three months in each of two consecutive years were considered having chronic bronchitis (CB), with no overlapping between these 2 groups. Data on occupational history and VGDF levels in the working area were collected from all participants. In total, 105 cases of COPD and 170 cases of CB were diagnosed in the cohort of examined workers. Occupational exposure to VGDF was twice as often present among COPD patients than among both patients with CB and the control group of healthy workers (p<0.05). More than 40 % of COPD patients were occupationally exposed to VGDF above the value of 3.0 of the occupational exposure limit (OEL) and more than 20 % to 6.0 OEL and higher. Overall odds ratio for COPD development due to occupational VGDF exposure was 5.9 (95 % CI=3.6 to 9.8, p=0.0001). Both smoking and VGDF seem to be important for the development of COPD. Analysis of the combined effect of tobacco smoking and occupational noxious particles and gases on COPD development has shown the following order of risk factors based on the strength of their infl uence: VGDF levels, smoking index, age, and heating microclimate. There is a statistically signifi cant level of relationship and “dose-effect” dependence between occupational exposures to VGDF and the development of COPD. The effect of VGDF composition on the probability of COPD development was not found in the study. Results of this study were used to substantiate the inclusion of COPD into the National List of Occupational Diseases of the Russian Federation.Cilj ovog rada bio je potvrditi prevalenciju kronične opstruktivne plućne bolesti (engl. chronic obstructive pulmonary disease, COPD) među industrijskim radnicima u Ruskoj Federaciji i utvrditi relativni doprinos pušenja i profesionalnih čimbenika razvoju COPD-a. Odabrali smo 1.375 radnika u dobi od 30 godina i starijih. Šeststo dvadeset i četiri radnika bila su izložena parama, plinovima, prašini i dimovima (engl. vapours, gases, dust, and fumes – VGDF) na radu. Svi su radnici bili podvrgnuti fi zičkom pregledu i temeljnoj spirometriji. Za radnike koji su imali smanjen protok zraka (FEV1/FVC<0,70) smatralo se da imaju COPD, a za one koji su imali kašalj i pojačan sputum barem 3 mjeseca tijekom dvije uzastopne godine smatralo se da boluju od kroničnog bronhitisa (CB). Između ove dvije skupine nije bilo preklapanja. Od svih su sudionika prikupljeni podaci o radnoj anamnezi i razinama izloženosti VGDF-u na radu. Profesionalna izloženost VGDF-u bila je dvostruko češće prisutna kod radnika s COPD-om nego kod radnika s CB-om i kod kontrolne skupine zdravih radnika (p<0,05). Više od 40 % bolesnika s COPD-om bilo je profesionalno izloženo VGDF-u iznad 3,0 OEL (engl. occupational exposure limit – granica profesionalne izloženosti), a više od 20 % granici od 6,0 OEL i više. Ukupni omjer izgleda (engl. odds ratio – OR) za razvoj KOPB-a zbog izloženosti VGDF-u bio je 5,9 (95 %-tni CI=3,6 do 9,8; p=0,0001). Čini se da su i pušenje i VGDF važni za razvoj COPD-a. Analiza sjedinjenog učinka pušenja i profesionalne izloženosti štetnim česticama i plinovima na razvoj COPD-a pokazala je ovakav redoslijed čimbenika rizika prema jačini njihova utjecaja: razine VGDF-a, indeks pušenja, dob i mikroklima grijanja. Postoji statistički značajna veza i ovisnost „doza-učinak“ između profesionalne izloženosti VGDF-u i KOPB-a. Utjecaj sastava VGDF-a na vjerojatnost razvoja COPD-a nije utvrđen u istraživanju. Rezultati ovog rada potvrdili su potrebu uvrštavanja COPD-a u Nacionalni popis profesionalnih bolesti Ruske Federacije

Current Status and Prospects of Occupational Medicine in the Russian Federation

An in-depth analysis conducted on the historical background and current status of occupational medicine in Russia is presented. Scientific and practical bases of occupational medicine in the Russian Federation were based on 2 of the most important principles of health service: free medical care and its preventive orientation. Our analysis of the current situation in occupational medicine in modern Russia shows a transition from the vision of zero occupation-related harm to the strategy of recognizing, assessing, and managing occupational exposures. The system of workplace monitoring is developing successfully, with the creation of a federal database for the state of working conditions and the implementation of mechanisms for occupational risk assessment and management. However, at the same time, the system of medical surveillance for workers needs substantial reform. Over the past few years, the professional community of specialists in occupational medicine has taken several steps to improve the quality of its work. Understanding of the need for reforming the system of occupational medicine has continued to grow, which will improve the quality of medical monitoring for workers and extend professional longevity. Current challenges and prospects of occupational medicine in the Russian Federation are discussed

A comparative assessment of major international disasters: the need for exposure assessment, systematic emergency preparedness, and lifetime health care

Abstract Background The disasters at Seveso, Three Mile Island, Bhopal, Chernobyl, the World Trade Center (WTC) and Fukushima had historic health and economic sequelae for large populations of workers, responders and community members. Methods Comparative data from these events were collected to derive indications for future preparedness. Information from the primary sources and a literature review addressed: i) exposure assessment; ii) exposed populations; iii) health surveillance; iv) follow-up and research outputs; v) observed physical and mental health effects; vi) treatment and benefits; and vii) outreach activities. Results Exposure assessment was conducted in Seveso, Chernobyl and Fukushima, although none benefited from a timely or systematic strategy, yielding immediate and sequential measurements after the disaster. Identification of exposed subjects was overall underestimated. Health surveillance, treatment and follow-up research were implemented in Seveso, Chernobyl, Fukushima, and at the WTC, mostly focusing on the workers and responders, and to a lesser extent on residents. Exposure-related physical and mental health consequences were identified, indicating the need for a long-term health care of the affected populations. Fukushima has generated the largest scientific output so far, followed by the WTCHP and Chernobyl. Benefits programs and active outreach figured prominently in only the WTC Health Program. The analysis of these programs yielded the following lessons: 1) Know who was there; 2) Have public health input to the disaster response; 3) Collect health and needs data rapidly; 4) Take care of the affected; 5) Emergency preparedness; 6) Data driven, needs assessment, advocacy. Conclusions Given the long-lasting health consequences of natural and man-made disasters, health surveillance and treatment programs are critical for management of health conditions, and emergency preparedness plans are needed to prevent or minimize the impact of future threats