[METHODOLOGICAL APPROACHES TO THE ASSURANCE OF SANITARY-EPIDEMIOLOGICAL WELFARE ON THE BASE OF THE METHODOLOGY OF POPULATION'S HEALTH RISK MANAGEMENT].

In the article there is considered the practice of the application of the current legislative regulatory and procedural base for the occupational health and labor medicine (hygiene) issues. There are discussed issues of the assessment of occupational risks in enterprises of the Sverdlovsk region. There are proposed approaches to the creating the occupational risk management and assessment systems.

[PCR-diagnostics in investigation of Legionnaires' disease outbreak].

Results of studies of biological samples from patients with community-acquired pneumonia and samples from environment during Legionnaires' disease outbreak in town Verkhnyaya Pyshma (Sverdlovsk region) in July-August 2007 performed by PCR analysis are presented.

[Epidemiologic situation on pneumonia incidence in population of Sverdlovsk region in 2006-2007 and goals for improving of system for epidemiologic surveillance].

Personalized system for registration of community-acquired pneumonia cases instituted in Sverdlovsk region in 2002 is able to provide completeness of identification, accounting, and registration of pneumonia cases as well as to organize regular medical follow-up for survived persons. In addition, the automated system allows to conduct operative and retrospective analysis of morbidity according to area, age and social groups with identification of casual and risk factors as well as to timely organize the complex of preventive measures in an area.

[Organizational support of investigation of Legionnaires' disease outbreak in town Verkhnyaya Pyshma].

Materials on organizational support of preventive and antiepidemic measures during outbreak of Legionnaires' disease in town Verkhnyaya Pyshma (Sverdlovsk region) in July-August 2007 are presented. Thanks to collaborative efforts of Federal Service for Surveillance for Protection of Consumers Rights and Human Welfare, Ministry of Health of Sverdlovsk region, health-care services in Verkhnyaya Pyshma, near located municipalities, and others it was able to establish in short term the hospital for treatment, identify source of the infection and factor of its transmission, and terminate the outbreak. Operative implementation of the mentioned measures both allowed to provide good quality medical care to all patients and to prevent occurrence of such situations on other towns of Sverdlovsk region.

[Sanitary-epidemiological situation in town Verkhnyaya Pyshma in 2006].

Information on medical and demographic as well as sanitary-epidemiologic situation in town Verkhnyaya Pyshma is presented. The town belongs to group of territories with unfavourable ecologic situation. It was shown that social, economical, and sanitary-hygienic factors influence on public health. Priority pollutants of environment and indicators of public health are presented. For solving problems of protection of public health, ensuring the sanitary-epidemiologic welfare and ecologic safety in modern conditions, more effective, accessible, and economical mechanisms of management of environment and public health should be introduced with respect to action of factors of economical and social development of municipality as well as to realization of national projects.

[The forces and expedients of institutions of Federal Service for Surveillance for Protection of Consumers Rights and Human Welfare in Sverdlovsk region in elimination of focus of Legionnaires' disease].

Organizational issues as well as composition of forces and tools involved in elimination of focus of Legionnaires' disease were reviewed. Role of institutions of Federal Service for Surveillance for Protection of Consumers Rights and Human Welfare and their special units in general system of measures for elimination of the disease's focus was reflected.

[Experience of organization of flushing and disinfection of centralized system of hot water supply in town Verkhnyaya Pyshma after its colonization by Legionella].

Causes of outbreak incidence of pneumonia due to Legionella infection in population of Verkhnyaya Pyshma as well as factors promoting colonization of town's hot water supply system by Legionella were discussed. Experience of organization of flushing and disinfection of hot water supply system was described, effectiveness of different methods of disinfection was evaluated.

[Epidemiologic situation and measures for prevention of infectious diseases in Sverdlovsk region in 2006-2007].

Materials characterizing the epidemiologic situation on most significant infectious diseases in Sverdlovsk region are presented. Experience on providing the epidemiologic welfare based on systematic surveillance for activity of various factors influencing the epidemic process is described.

[Work with public in foci of infection during outbreaks of pneumonia caused by Legionella in town Verkhnyaya Pyshma in July-August 2007].

One of the key elements in epidemiologic control for infectious diseases is timely and active identification of contacts, which results in in-time hospitalization of patients that are needed it and allows to conduct educational work with the public. Measures for outpatient medical and preventive help in Legionella infection which were developed on the experience of termination of outbreak of pneumonia caused by Legionella in town Verkhnyaya Pyshma in July-August, 2007 are presented.

[Epidemiologic versions in investigation of Legionnaires' disease outbreak in town Verkhnyaya Pyshma].

Materials of investigation of Legionnaires' disease outbreak in one of the town of Sverdlovsk region in summer 2007 are presented. Outbreak arose in situation of epidemiologic welfare on majority of registered infectious diseases. Epidemiologic diagnostics of the outbreak has been performed in maximal shorttime interval, during which it was necessary to investigate variety of miscellaneous versions. Active search of the source of the infection and its transmission factors resulted in desired result and allowed to terminate the outbreak in 14 days.

[Organization of medical care of patients with pneumonia caused by Legionella during outbreak in Sverdlovsk region].

Data on organization of medical care during outbreak of Legionnaires' disease in July-August, 2007 in town Verkhnyaya Pyshma in Sverdlovsk region are presented. Special feature of this outbreak was spreading of infection in boundaries of the town with total population of 70,600 people. Results of organizational work of health authorities in order to provide timely and adequate medical care for patients with Legionnaires' disease on both outpatient and inpatient levels of care, conduction of preventive measures in foci of infection, coordination of interaction between different medical organizations and services are summarized in the article.

[Epidemiologic characteristic of Legionnaires' disease outbreak in town Verkhnyaya Pyshma].

Materials of investigation of Legionnaires' disease outbreak in town Verkhnyaya Pyshma (Sverdlovsk region) are presented. Features of epidemic process during this outbreak were reflected, its epidemiologic characteristics were described. Effectiveness of timely antiepidemic measures directed at elimination of main factor of infection's transmissibility was shown.

[A role of the sociohygienic monitoring system in the maintenance and promotion of the population's health (in case of the Sverdlovsk Region)].

The paper summarizes the results of implementation of the sociohygienic monitoring system in the Sverdlovsk Region, the stages of the populational and individual diagnosis, by using a risk-assessing methodology and current environmental and epidemiological studies. Sociohygienic monitoring allowed the priorities to be determined in health maintenance and promotion in the population of this region. The accumulated experience illustrated by some examples that have been earlier published in detail supports the need for a relationship of the above guidelines within the sociohygienic monitoring system, for the development of mechanisms responsible for risk management and further improvement of surveillance of the sanitary and epidemiological situation.

[Rehabilitation of the population living in poor environmental areas in the Sverdlovsk Region].

Medical rehabilitation of the population living in poor environmental areas has been realized since 1999 and is the basis for environmental safety policy in the Sverdlovsk Region, along with the prevention and reduction of environmental pollution, the rational use, conservation, and replenishment of natural complexes. Medical rehabilitation activities for the population's health are aimed at managing the risks associated with human environmental factors, managing address medical prophylactic services, individual behavioral factors, habits, and awareness of the population. Interaction of the participants of the medical rehabilitation system provides for tackling the set health promotion tasks in the Sverdlovsk Region.

Some considerations concerning multimedia-multipollutant risk assessment methodology: use of epidemiologic data for non-cancer risk assessment in Russia.

The highly industrialized small town of Verkhnyaya Pyshma (in the Urals region of Russia) was chosen as the site of a multimedia-multipollutant risk assessment using the U.S. Environmental Protection Agency methodology. The assessment was based on routine environmental pollution monitoring data for ambient air, soils, drinking water, and food, and the international environmental epidemiology literature. Using an a priori set of the preliminary health-based criteria, we selected nine pollutants for risk assessment: total suspended particles (TSP), sulfur dioxide, nitrogen dioxide, benzo(a)pyrene (BaP), ammonia arsenic, copper, cadmium, and lead. We used dose-response functions derived from epidemiologic studies to assess individual and population risks for TSP, SO2, NO2, As, Cd, and Pb. We assessed both cancer (for BaP, As, and Cd) and non-cancer (for all the chosen pollutants but BaP) responses, but in this paper we discuss only the assessments of noncarcinogenic risks due to TSP, SO2, NO2, Pb, and Cd as examples of how the quantitative estimates of health effects can be produced by using a risk function approach. We also schematically present a modified conceptual model of multimedia-multipollutant risk assessment taking into account the experience gained with this study.

[Ecologo-epidemiologic studies in the social-hygiene monitoring system (experience in the Sverdlovsk region)]. / Ekologo-épidemiologicheskie issledovaniia v sisteme sotsial'no-gigienicheskogo monitoringa (opyt Sverdlovskoi oblasti).

Surveys made in the Sverdlovsk Region suggest that a procedure for evaluating a risk in combination with ecological and epidemiological surveys greatly enhances the potentialities of predicting and detecting human environment-related diseases and both approaches deserve a wide introduction into the socio-sanitary monitoring system.

[On hygienic standards of the allowable levels of suspended particles in the air]. / K voprosu o gigienicheskom normirovanii dopustimogo soderzhaniia vzveshennykh chastits v atmosfernom vozdukhe.

Elevation of average daily concentrations of suspended particles in air, even being within the MAC, could be associated with higher mortality in general population and deteriorated respiratory symptoms in children, especially in those having chronic respiratory diseases with bronchial obstruction. Discussion on reduction of MAC for suspended particles is expendient with wider practice of fraction measurement their concentrations.

[Some results of the used methodology for the evaluation of risk in the Sverdlovsk region]. / Nekotorye itogi ispol'zovaniia metodologii otsenki riska v usloviiakh Sverdlovskoi oblasti.

The authors represent a scheme of conceptual model for methodology to evaluate health risk caused by environmental pollution. The model is based on analysis of literature and the authors' experience.

[Hygienic regulation of environmental air pollution with consideration of epidemiological data]. / O gigienicheskoi reglamentatsii zagriazneniia atmosfernogo vozduha s uchetom épidemiologicheskikh dannykh.

The authors hold that the maximum allowable concentrations (MAC) established in Russia for some ambient air pollutants can adversely affect human health and that they are worthy of reconsideration. This opinion is based on the published results of epidemiological studies of Western investigators and on the authors' own data obtained from the analysis by the time series method for a relationship of daily variations of dust or gaseous ambient air pollution to the so-called acute mortality or for that of the variations to respiratory symptoms and to the values of the maximum expiratory flow rate in preschool with or without respiratory abnormalities in their history; from the cross analysis of an association of the characteristics of atmospheric contamination in 13 urban areas with the prevalence of chronic respiratory diseases in junior schoolchildren, which was established by a special questionnaire. Particular emphasis should be laid on the reconsideration of not only established values, but mainly on the principles in laying down MAC for dust particles. The Western practice in measuring and evaluating risks separately for fractions of particles of varying sizes should be assessed for its use in Russian conditions; however, the authors' experience argues for this practice.

[Rehabilitation for dwellers of ecologically unfavorable territories of Sverdlovsk region]. / Reabilitatsiia zdorov'ia naseleniia na ékologicheski neblagopoluchnykh territoriiakh Sverdlovskoi oblasti.

The article covers organizational and methodic aspects associated with creation of rehabilitation system for dwellers of ecologically unfavorable territories of Sverdlovsk region.