The article describes the current state of labour conditions and occupational morbidity, as well as measures to improve medical examinations of employees of mining companies. Hygienic studies have shown that labour conditions at these operations were and remain harmful. A general assessment of the workplace conditions of the main jobs at these companies corresponds to the 3rd and 4th Subclasses of Hazard Class 3. The levels of occupational morbidity and its structure are presented. More than 70% of newly detected occupational diseases in both underground and open-pit mining were registered among persons whose workplaces were classified as Subclasses 3.3-3.4. The article provides recommendations on conducting preliminary and periodical examinations of workers in accordance with the provisions of Order No. 988n/1420n of the Ministry of Labour and Social Protection and the Ministry of Health of the Russian Federation dated December 31, 2020, and Order No. 29n of the Ministry of Health of the Russian Federation dated January 28, 2021, that were introduced on April 1, 2021.

An analysis of the literature and an essay on the problem of recognizing the diseases of workers — diagnosis and causation(work-relatedness assessment) are given. A historical reference is made on the etiology of workers’ diseases and the statements of the classics about the causality in medicine. The main categories of occupational medicine and terminology of the WHO and ILO, the principles of evidence in occupational health are considered. The WHO concept of work-related diseases (WRD), occupational disease (OD) recognition systems under ILO Convention No. 121, features of the ILO occupational diseases list (revision 2010), and the criteria for inclusion of diseases in this list are presented.The general provisions of causation, types of causation algorithms in consensus and evidence-based medicine, as well as a generalized algorithm for analyzing periodic medical examinations data are considered. The European experience of recognition of WRD is considered. Based on experience and literature data, we propose a 10-step causation algorithm, including forecasting the probability of OD and WRD, as well as quantifying the degree of work-relatedness with computer support programs from the electronic directory «Occupational Risk» (http://medtrud. com/). It is concluded that legal recognition of WRD is needed for early diagnosis and prophylaxis of workers’ health disorders in conditions of digitalization of the economy and society.

Currently, the normative acts do not define the priority and order of interaction (routing) between various types of medical examinations (examinations) working during mandatory, preventive medical examinations and medical examination. The order of action of doctors in the diagnosis of diseases at various stages of the examination has not been determined.

Цель. Провести сравнение результатов прогнозирования риска иБС по шка-лам sCOre, PrOCAM и framingham, а также вновь разработанным моделям риска иБС в когорте работников железнодорожного транспорта. Материал и методы. В исследование включено 106 пациентов-работников локомотивных бригад, которые находились под медицинским наблюдением в период с 2006 по 2015гг с проведением регулярных периодических и пред-рейсовых осмотров, углубленного обследования в кардиологическом отделе-нии. Диагноз иБС устанавливали при выявлении документально подтвержден-ных признаков коронарной ишемии миокарда, коронарного атеросклероза (по данным коронарографии, МСКТ). индивидуальный суммарный сердечно-сосу-дистый риск определяли по шкалам sCOre, PrOCAM, framingham и моделям прогнозирования иБС, полученным с использованием метода главных компо-нент (PCA), вероятностных нейросетей (PNN), деревьев решений (decisionTree) на основе комплекса показателей (включая индекс массы тела, липопротеиды низкой плотности, триглицериды, пульсовое АД и др.). Качество моделей оце-нивали по показателям чувствительности, специфичности, средней абсолютной ошибки прогнозирования, площади под rOC-кривой (AUC). Результаты. распределение на категории риска (низкий, умеренный, высокий) по калькуляторам sCOre, PrOCAM и framingham характеризовалось противоре-чивыми результатами; в группе с иБС при низком риске по этим шкалам сер-дечно-сосудистые события (инфаркт миокарда и/или операция на коронарных артериях) отмечались у 51,9%, 5,56% и 42,6%, соответственно. AUC для sCOre, PrOCAM и framingham в определении класса "иБС" были равными 0,72, 0,65 и 0,69, соответственно, но класса "инфаркт миокарда" -только 0,34, 0,42 и 0, 32. AUC для модели PNN для классов "иБС" составила 0,55, "инфаркт миокарда" -0,60. Средняя абсолютная ошибка прогнозирования высокого риска иБС по шка-лам sCOre, PrOCAM и модели PNN составила 0,88, 0,56 и 0,46. заключение. Шкалы sCOre, PrOCAM и framingham характеризуются несогла-сованностью результата устанавливаемой категории риска иБС и недостаточной точностью в отношении прогнозирования инфаркта миокарда в когорте мужчин среднего возраста, работающих на железнодорожном транспорте, что ограничи-вает их применение. разработанная модель PNN показывает, что ошибка про-гноза ниже у моделей с включением дополнительных факторов (пульсовое давле-ние, тромбоциты, триглицериды, индекс массы миокарда и др.). Aim. To conduct a comparison of iHd risk prediction with the sCOre, PrOCAM and framingham scores, as novel developed models of iHd risk in cohort of the railroad workers. Material and methods. Totally, 106 patients included -workers of locomotive crews, who had been under medical observation during 2006-2015 years with regular scheduled physician observations, incl. preflight, in-depth investigation during in-patient cardiological hospitalization. iHd diagnosis was set if documentarily confirmed signs of coronary ischemia of myocard were found, or coronary atherosclerosis (by angiography, MdCT). individual total vascular risk was estimated by sCOre, PrOCA...

Introduction. Typology of diurnal (circadian) human rhythms is actively studied in occupational medicine, from the viewpoint of adaptation to various work conditions including those with shift working schedule. In recent years, evidences outline bimodal chronotype characterized by simultaneously present signs of extreme morning and extreme evening types without dominating one of them. Studies did not cover bimodal chronotype in night-shift workers.Objective is to evaluate presence of bimodal chronotype in night-shift workers if compared to day-shift schedule.Materials and methods. Chronotype outlining covered 95 workers divided into 2 groups: first — 55 night-shift workers, second — 40 workers on day schedule. Bimodal chronotype was diagnosed via algorithm based on questionnaire Morningness Eveningness Questionnaire (MEQ) by B.J. Martynhak et al.Results. Findings are that 7.3% of night-shift workers and 5.0% of workers with day schedule demonstrate bimodal chronotype. Changed chronotype classification leads to smaller share of workers with intermediate chronotype, but quota of morning and evening chronotypes does not change. Possibility of bimodal chronotype should be respected in examination of workers for designing health programs with consideration of chronotype-associated diseases and for better performance due to rational management of working time.Conclusions. Diagnosis of individual chronotype is a serious part in health programs formation in able-bodied population. Chronotype knowledge helps to minimize possible decrease and losses of performance due to rational working time management and preventive programs aimed to diagnose chronotype-associated health disorders.