[The dynamics of indices of professional self-evaluation and social status of physicians: the first results of reforms in health care system].

In Russia, an active transformation of national health care system takes place and one of the most important of its activities became approval of the "road map". In 2017, survey of physicians was carried out that revealed a number of patterns and problems in the field of physicians perception of their own lives, social self-implementation. In 2019, survey was re-carried out covered 311 specialists from the Republic of Bashkortostan. The purpose of this study was to analyze the dynamics of indices of professional self-assessment and social status of physicians in 2017-2019. The results testify a number of significant changes that took place by 2019: 1) number of specialists evaluating their own competence as "Excellent" statistically significantly increased (p=0.015); 2) percentage of specialists of second qualification category significantly decreased (p=0.0068) and previously observed relationship between professional self-assessment and qualification category lost its significance; 3) physicians began to statistically significantly more often identify themselves with highest stratum of society (p=0.012); 4) situation associated with lack of free time (p=0.021) and fears of losing job (p=0.044) worsened significantly. The research data mainly testify positive changes in social well-being of physicians in 2017-2019 and can be considered as first results of reform of national health care system. Nevertheless, increase of deficiency of free time and fears of losing job requires development and implementation of appropriate preventive measures.

Early diagnostic and prognostic criteria for health disorders in chemical workers.

The production of synthetic materials - fiberglass and rubber-technical products, as well as products derived from oil refining wastes continues to grow. A characteristic feature of the working conditions of these enterprises is the content of chemicals of hazard class 1-4, which may be potentially hazardous to workers. It imperative to justify prenosological laboratory criteria for health problems of manufacturing workers. The results of the hematological, biochemical, immunological and cytochemical parameters among manufacturing workers are presented. Significant changes in the processes of oxidative metabolism, lipid metabolism, impaired immune status, and intracellular enzyme activity were found in a significant proportion of the workers. Changes were detected in workers even with a short work experience (5 years) and of young age (20-30 years). With an increase in the occupational length of service, the frequency of these disorders increased. Based on the results obtained, early diagnostic and prognostic criteria for health disorders in workers of diverse chemical industries are substantiated. Based on the results obtained, early diagnostic and prognostic criteria for health disorders in workers of diverse chemical industries are substantiated. For rubber manufacturing workers: increased malonic dialdehyde, reduced catalase activity, the activity of catalase is lowering; increased enzymes activity (AST, ALT, GGT), protein abnormalities, erythropenia, decreased hemoglobin levels, increased reticulocyte. For fiber glass manufacturing workers: indicators of the oxidative antioxidant system, hemograms - increased lymphocytes, erythrocytosis, leukocytosis, increased CD3 +, increased CD4 +, CD 16+, CD 20 +, FAL, IgG, increased total protein, hyperfermentemia (GGT, ALT), changes in the intracellular enzymes activity - acid phosphatase of neutrophils and lymphocytes, decreased myeloperoxidase, increased glycogen levels. For olefin oxides manufacturing workers - this is hyperfermentemia (ALT, alkaline phosphatase), protein metabolism changes, increased red blood cells, reticulocytes, neutrophils, lymphocytes, eosinophils, platelets, leucopenia, decreased FAL, increased IgM, decreased IgA, IgG, changes in the intracellular enzymes activity - decrease myeloperoxidase, increase acid phosphatase of neutrophils and lymphocytes.

[The analysis of factors effecting professional self-assessment of physicians].

To explore the factors potentially related to professional self-assessment of physicians, sociological survey on the basis of sampling of 223 respondents who underwent professional training in 2017 was organized. The physicians with the first qualification category more often assessed themselves as "good" than other respondents (p=0.049). On the contrary, physicians with no qualification category rated their work as "good" less often and as "satisfactory" more often than other respondents (p=0.041 and p=0.010, respectively). The rate of professional self-assessment as "excellent" significantly increased among physicians identifying themselves with highest stratum of society (p=0.00034). Statistically significant differences in age, total duration of service in profession between physicians assessing their work for "excellent", "good" and "satisfactory" were not detected (p>0.05). The most frequent problems complicating life of physicians and their families were "Fatigue, overwork" (69.06%), "lack of free time" (60.09%), "low income" (44.39%). The reliable relationship between these factors and professional self-assessment was not detected (p>0.05). The relationship between professional self-assessment and availability of qualification category, as well as stratum of society to which they relate themselves, was established.

[Expression of Cell Cycle, Oxidative Stress, and Apoptosis Related Genes Chek1, Hmox1, Casp7 in Rat Liver Exposed to Carbon Tetrachloride].

Carbon tetrachloride is a well-studied hepatotropic poison. Animal models of exposure to carbon tetrachloride resemble acute liver damage in humans. This paper presents the study of the expression of genes related to cell cycle control, apoptosis, and oxidative stress in a model of carbon tetrachloride-induced toxic hepatitis in rats. White mongrel male rats were injected with a 50% oil solution of carbon tetrachloride at a dose of 0.125-4.000 g/kg (experimental group) or olive oil (control group). The animals were decapitated 24 and 72 h after the administration of carbon tetrachloride, and the qRT-PCR expression levels of the genes encoding hemoxygenase-1 (Hmox1), cell cycle checkpoint kinase-1 (Chek1), and caspase-7 (Casp7) in the liver were analyzed. The increase in the expression levels of Hmox1 and Chek1 after exposure was detected. These genes may either play a role in promoting pathological oxidative stress in the liver or be a part of a stress response. We have concluded that the major pathway of the liver damage in carbon tetrachloride exposed animals is necrosis rather than apoptosis.

[Etiological significance and antibioticosensetivity of certain microorganisms in aggravation of chronical bronchopulmonary pathology in workers of diverse economic sectors.]

It has been shown that in patients with upper respiratory diseases of occupational etiology gram negative flora prevail (38% of cases). They are followed by yeast-like fungi (up to 36% of cases), gram positive flora - 26%. The most effective antibacterial agents for treating golden staphilococcus in patients of the group studied are cefotaxime, sparfloxacine, levofloloxacine. Cefotoxime, ceftriaxon, ciprofloxacine are used against intestinal bacteria. Cefepim, ceftazidim are used against non-fermenting gram negative bacteria. C.Albicans can be treated with amfotericine and fluconazol.

[Dependence of dental status from the level of endogenous intoxication in chemical industry workers based on the oral fluid composition study]. / Zavisimost' otklonenii stomatologicheskogo statusa ot urovnia éndogennoi intoksikatsii u rabotnikov khimicheskogo proizvodstva: rezul'taty izucheniia sostava rotovoi zhidkosti.

The aim of the study was to assess the dependence of dental status from the level of endogenous intoxication in chemical industry workers. Dental examination and analysis of the composition of the oral fluid were performed in 101 workers dealing with production of chlorophenoxyherbicides (CPH) and 100 individuals of the control group having no contact with harmful production factors. The survey revealed higher intensity of dental caries among workers (RR=1.2), which is in direct correlation with the duration and degree of contact with toxicants (rxy=+1.0). It is established that the incidence, intensity and severity of periodontitis are associated with the duration and degree of contact with CPH. The study also revealed an 80% reduction in antioxidant defense in workers. The level of malonic dialdehyde (MDA) in the main group was 4 times higher (p<0.01, RR=4), while oligopeptides of average molecular weight (OAMW) - 2.2 times higher than in controls (p<0.01; RR=2.2), indicating increased lipid peroxidation and endogenous intoxication of workers of chlororganic production. MDA and OAMW levels correlated positively with the degree of involvement in chlororganic production (MDA: RR=5.6; p<0.0; OAMW: RR=3; p<0.001; rxy=+0.894) and employment duration (MDA: RR=4.4; p<0.05; rxy=+of 0.922; OAMW: RR=2.4; p<0.01). The estimation of the parameters of oral fluid is a non-invasive method for screening for occupational intoxication and the formation of risk groups.

[Nutritional assessment of adult population of the Republic of Bashkortostan].

The study of actual nutrition of Bashkortostan adult population using hygienic and statistical methods has been carried out. Based on the data on the nature and quantity of food consumed, the tables of the chemical composition of Russian food products and the results of own findings, nutritional and energy value of the average food set have been calculated. According to the data of the Federal State Statistics Service and the questionnaire survey of 1328 people (821 women and 507 men aged 25-60 years 1-3 groups of physical activity living in urban and rural areas), the consumption structure of basic food products (meat, eggs, potatoes, vegetable oil, sugar, bread) has been shown to be similar on the average in Russia and in the Republic of Bashkortostan, despite the presence of some specific peculiarities. People living in Bashkortostan consumed 30% more dairy products, while fish consumption was 2 fold lower, intake of fruits and vegetables reduced by 28%. When compared with rational norms, consumption of bread and sugar by Bashkortostan residents was 1.4 and 1.9 fold higher, vegetables, fruits, fish and seafood - was lower in 2.2, 2.6 and 2.7 fold, respectively, which largely affects the chemical composition of the diet. The energy value of food consumed was composed of 45% of carbohydrates, 42% of fats, 13% of proteins and consisted on average of 2812±196 kcal per day among men, and 2229±136 kcal among women. The diet imbalance of basic foods lead to a deficiency in the diet of calcium (by 25%), magnesium (15%) and vitamin C (50%), B1 (30%), B2 (45%), A (28%). The creation of a permanent information and promotion system to educate the population about the basic principles of healthy eating, the prevention of alimentary-dependent diseases, an increase in the production of food products of mass consumption with reduced fat, sugar, salt, enriched with vitamins and minerals can be recommended as an urgent measure for improving nutrition of the Republican population.

Production and genetic risk factors for cardiovascular diseases among petrochemical industry workers.

AIM: To study the production and genetic factors affecting the cardiovascular system (CVS) in the petrochemical industry workers. MATERIALS AND METHODS: There was carried out an assessment of the working conditions and the state of health of 860 workers of petrochemical plants males, including 548 apparatchiks (main group) and 312 fitters of instrumentation and automation (comparison group). The main risk factors with subsequent assessment of cardiovascular risk (SSR) on the scale SCORE (Sistematic COronary Risk Evaluation) were studied. The analysis of the frequency distribution of deletion polymorphisms of GSTM1 and GSTT1 glutathione among the workers of the basic trades involving patients with cardiovascular disease (CVD) and practically healthy workers. RESULTS: The development and progression of CVD in petrochemical production workers affects a complex working environment hazards and the labor process, corresponding, according to R2.2.2006-05, classes, working conditions 3.1-3.3 Labor intensity. The most common form of cardiovascular nosology was hypertonic disease (HD), identified in 46,9% of apparatchiks and 29,2% of fitters of instrumentation and automation. Determination of the relative risk etiological share of the working environment factors in the development of HD showed high degree of professional conditioning of the disease in a group of apparatchiks (RR=1,58, and EF=36,7%). Molecular genetic factor predisposing to the development of CVD, is the deletion of the GSTM1 gene. This genetic marker could be used as a predictor of individual risk criterion CVD. CONCLUSION: A comprehensive assessment of working conditions of workers of petrochemical plants showed that the priority factors of occupational risk for apparatchiks are air pollution of the working area with harmful substances (class 3.1-3.2), noise (class 3.1) and labor intensity (class 3.1). It has been established that in the formation of cardiovascular diseases under the influence of production factors, genetic factors can participate.

[Laboratory confirmation of staging and volume of preventive measures at work under the conditions of microbial pollution of work environment air.]

Conceptual and methodological basics of the medical surveillance system with confirmed staging and regulated volume of laboratory studies on workers of diverse industrial sectors exposed to increased microbial load with opportunistic infections have been developed.

[Major risk factors and cardiovascular disease prevalence among petrochemical workers].

Objective. Based on the assessment of occupational and non-occupational risk factors, development of preventive measures for the reducing of cardiovascular diseases (CVD) prevalence among petrochemical workers. Material and Methods. A total of 2,634 petrochemical workers have been examined. To identify modified and unmodified risk factors for cardiovascular diseases, comprehensive hygienic and clinical laboratory studies have been carried out. Results. The obtained results have shown a higher riskfor the development of cardiovascular disease among operators as compared to metal workers for instrumentation and automation repairs. Based on the assessment of risk factors, preventive measures implemented at personal and corporative levels have been developed.

[Structure and dynamics of occupational morbidity in Bashkortostan Republic].

The authors represent data on analysis of dinamics and structure of occupational incidence in Bashkortostan Republic, according to archive documents of Ufa Research Institute of Occupational Health and Human Ecology, on occupational morbidity dynamics over 2008-2014, on its regional peculiarities.

[GENETIC PREDISPOSITION TO DEVELOPMENT OF TOXIC HEPATITIS].

Aim: The aim of this study was to investigate the frequency of polymorphic variants of genes CYP2E1 and GSTA1 in patients with pathology of the hepatobiliary system (PHS) and healthy individuals in the Republic of Bashkortostan, as well as an analysis of possible associations of genotypes of this gene with the development of PHS. Materials and methods: There were examined 81 patients with pathology of the hepatobiliary system. Was studied association analysis of polymorphic loci of genes CYP2E1 and GSTA1. Results: The study demonstrated that a marker of risk of developing the disease is AA genotype (OR = 2,09; 95% CI 1,07-4,10) polymorphic locus gene rs3957357 GSTA1.

[Peculiarities of air pollution in the production of continuous glass fiber].

With the use of a one-stage method we have carried out hygienic studies of the air of work area of the production of continuous glass fiber. There was revealed the emission of epichlorohydrin, formaldehyde, ethane acid, hydrochloride, spray of mineral petroleum oil, fine glass fiber dust in air of the work area. There was established the combined effect of hazardous substances of unidirectional action with the summation effect on the body. Hazardous substances containing in glass fiber sizers in combination with dust of glass fiber against the background of microtraumatization of the hand skin contribute to the development of occupational skin neoplasms. The studies became the basis of the development of preventive measures aimed at the reduction of risks of the impact of the chemical factor impact on workers.

[The use of the antioxidant drink by healthy workers exposed to chemical factors].

In chemical manufacturing along with alimentary factors, workers are exposed to occupational hazards resulting in reduced antitoxic protective properties of the organism. The purpose of the present work was to develop a preventive method for reducing antitoxic functions of the body of healthy workers exposed to chemical factors. We have produced the drink containing carrot juice, honey, olive oil. The study involved 50 employees (the average age was 37.4±5.5 years) with experience of over 15 years. The main group (25 people) were workers with reduced antitoxic function who received the drink before each day's work shift for 10 days, the control group - workers with normal anti-toxic function, which did not take a drink. It was found that antioxidant drink intake by healthy employees of a chemical complex lead to the decrease of the level of molecules of average mass at λ=254 nm and at λ=280 nm by 15.1±7.2%, the activity of gammaglutamyl transferase - by 19.1%, alaninaminotransferase - by 44.1%, aspartataminotrans-ferase - by 34.7% (indicators of the syndrome of endogenous intoxication), the decrease of the content of malondialdehyde (as an indicator of an excessive accumulation of products of lipid peroxidation) - by 43.8%, while the activity of catalase, that indicates an increase in the antitoxic functions of the organism, increased by 37.5%.

[THE CHOLINESTERASE OF BLOOD SERUM IN WORKERS OF INDUSTRIAL ENTERPRISE].

The biochemical study of activity of serum cholinesterase in workers of industrial enterprise was carried out on the example of petrochemical industry. The indicators of average activity of enzyme and prevalence of indicators going beyond limits of reference values were analyzed depending on manufacturing-labor experience, profession and diseases established in workers. The main diseases, professional and labor experience groups were identified where activity of cholinesterase significantly changes. The impact of labor experience and profession on level of activity ofenzyme in blood serum is demonstrated.

[The laboratory markers of early metabolic disorders in workers of rubber Articles industry.]

The article presents results of complex laboratory analyses applied to workers of rubber articles industry using biochemical, hematological, immunological techniques. The study established the most expressed and early alterations of processes of oxidative metabolism (decreasing of catalase activity, increasing of level of malonic dialdehyde and uric acid) and indicators of lipid metabolism of blood serum. The increasing of percentage of persons with metabolic disorders related to length of service in industry is established. In examined workers signs of anemia (erythropenia, decreasing of level of hemoglobin) and leukopenia were detected. The imbalance of T-cell component (CD+ CD4+), accompanied by alteration of phagocyte activity and defect of humoral component with increasing of level of IgM and decreasing of level of IgA. The coefficients of diagnostic sensitivity of analyzed laboratory tests were established. The most significant laboratory markers permit diagnosing early metabolic disorders and degree of their expressiveness in workers of rubber articles industry.

[Analysis of associations of polymorphic loci of a tumor suppressor gene TP53 with malignant neoplasms in glass fiber manufacturing workers].

The purpose of the study was to determine the role of TP53 tumor suppressor gene polymorphisms in the occurrence of skin malignant neoplasms in glass fiber manufacturing workers. We carried out a comparative study of polymorphous loci Arg72Pro and dup16bp in TP53 gene in workers with skin cancer and hyperkeratosis (n = 68), occupied in continuous glass fiber manufacture, and in healthy workers (n = 52). The associations of both Pro and dup16 minor alleles of TP53 gene, and Arg/Pro-W/dup16 genotype combination with higher risks for skin oncologic diseases of occupational genesis have been revealed.

[The specific sensitization and local immunity of oral cavity in conditions of chronic aerogenic load].

The article considers the results of analysis of concentration of IgA, IgM, IgG, IgE, sIgA, sICAM-1 in non-stimulated saliva of female workers of poultry sector who underwent aerogenic impact of complex of occupational factors. The changes in indicators are analyzed depending on intensity of sensitization. The study demonstrated that the greatest changes in concentration of sICAM-1 are detected primarily in case of fungous infection.

[Specificities of intracellular metabolism in agricultural workers].

The purpose of the study was to identify and assess specific features of intracellular metabolism under the conditions of combined impact of biological and chemical work environment factors in agricultural workers. We have detected an activation of energetic and hydrolytic processes, suppression of antioxidant protection mechanisms in blood cells in workers of basic occupations. A most marked disorder of intracellular metabolism has been identified in poultry female workers. More significant activity deviations of acid phosphatase and glycogen in neutrophils and lymphocytes, myeloperoxidase in neutrophils have diagnosed in these workers.

[Effect of ivabradine on pulmonary hypertension in chronic obstructive pulmonary disease].

In order to assess effect of If-channel blocker ivabradine on severity of pulmonary hypertension in chronic obstructive pulmonary disease (COPD) we studied 60 patients with III-IV stage COPD. We divided these patients into 2 groups with similar clinical characteristics and therapy. Patients of one of these groups received ivabradine (10 mg/day) for 2 weeks, patients of another served as controls. The use of ivabradine was associated with statistically significant lowering of pulmonary hypertension, heart rate, and increase of exercise tolerance without negative effects on myocardial contractility, electrophysiological parameters, or data of spirometry.