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.

COPD and occupation: a retrospective cohort study of industrial workers.

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.