Health Status and Optimization of Medical Care for Flight Attendants of Civil Aviation

The dissertation is dedicated to a comprehensive study of the health status of flight attendants of civil aviation and the development of measures for the optimization of medical care for this professional group. The work analyzes the impact of industrial-professional factors — overloads, hypoxia, barometric fluctuations, vibration, changes in time zones, and others — on the organism of flight attendants, as well as identifies patterns of somatic and gynecological morbidity depending on age and length of flight service. For the first time under the conditions of the existing healthcare system, the author conducted a systematic study of the organization of medical care for flight attendants, including the analysis of dispensary observation, outpatient clinic service, and inpatient care.

The research includes a clinical analysis of the structure of hospitalized gynecological morbidity, an assessment of the menstrual-ovarian cycle and hormonal profile of flight attendants, and a sociological survey that allows for the evaluation of medical activity and staff motivation to preserve health. Based on the obtained results, practical recommendations have been developed for the improvement of preliminary and periodic medical examinations, the enhancement of the quality of dispensary examination, and the optimization of the organization of medical care for flight attendants of civil aviation.

Relevance of the Topic

Aviation medicine, always at the forefront of the latest scientific and practical developments, is at the present stage undergoing a period of multifaceted introduction of knowledge-intensive technogenic research methods into the practice of medical-flight examination (Razsolov N.A., Kolesnichenko O.Yu., 1999). The problem of bringing the conditions of functional examination of flight personnel closer not only to real-life conditions but also to flight conditions has long been a relevant topic of research by specialists in aviation and space medicine, who more than 30 years ago first developed methods of special diagnosis (Komendantov G.L., Alifanov V.N., Razsolov N.A., 2002), with the aim of assessing the influence of flight work factors on the organism of pilots and flight attendants, simulating them by special functional tests.

The improvement and development of medical care for employees of aviation enterprises is a sufficiently difficult task to implement, acquiring increasing relevance and urgency. Under modern conditions, the organization of medical care for workers is usually narrowed to the level of current work, when behind a specific diagnosis, sick-leave certificates, methods of treatment and rehabilitation, preventive examinations, the strategic line of preserving the health of employees of aviation industry enterprises is lost.

Under modern conditions, particular interest is represented by the study of the health of a population group of people united by a single technology in the sphere of air transport, in particular flight attendants. In addition to general socio-economic problems, they are characterized by a complex of adverse industrial-professional and emotional factors, which include: overloads (accelerations) during takeoff and landing, barometric pressure fluctuations, hypoxia, unfavorable microclimatic factors, thermal and radiofrequency radiation, electric and atmospheric fields, vibration, reacclimatization during long-distance flights, changes in time zones during transmeridian flights, overexertion, and others.

At the end of the XX century, under conditions of unsystematic reforms of healthcare against the backdrop of a deficit of budget financing in medical and preventive institutions of the country, attention to dispensary examination issues weakened (Kucherenko V.Z., Syrtsova L.I., 2002, Alekseeva V.M., 2003). However, a sufficiently high level of dispensary examination was preserved in individual ministries, including among workers of air transport, which is due to the necessity of creating conditions for the safety of airliner movement. At the same time, until recently, the continuity of the dispensary examination system for flight attendants was insufficiently developed, and dispensary observation periods were not always observed. Moreover, there exists a number of gynecological diseases that occur significantly more frequently in the studied group than in the general population of women of reproductive age (Sorokina T.A., Kudinova A.O., 1991). Unfortunately, the undeniable achievements of occupational medicine in the aviation sector accumulated to date are used mainly for issuing negative expert decisions, and the organization of medical care for flight crew and flight attendants is focused on secondary prevention, when the physician's attention is concentrated on organic diseases arising against the background of functional disorders and their possible complications. Radical improvement of the system of diagnostic, therapeutic care, examination, and dispensary examination is possible only on the basis of scientific data. This means that detailed study of the influence of flight work on gynecological morbidity is extremely important, since it concerns the preservation of general and reproductive health in a numerous and constantly increasing professional group. With regret, it must be noted that works devoted to the reproductive health of women in aviation are isolated and in many respects are of an occasional character.

All of the above dictated the necessity of this research for the optimization of the system of organization of medical care for flight attendants of civil aviation.

Research Objective: based on the analysis of the health status of flight attendants of civil aviation, to develop measures for the optimization of medical care. Research Tasks:

1. To study the health status and organization of medical care for flight attendants of civil aviation (based on literature data).

2. To analyze the general and gynecological morbidity of flight attendants of civil aviation based on outpatient clinic attendance data and medical examination data.

3. To conduct a clinical analysis of the structure of hospitalized gynecological morbidity among flight attendants of civil aviation.

4. To analyze the state of the menstrual-ovarian cycle in flight attendants of civil aviation.

5. To develop proposals for the improvement of medical care for flight attendants of civil aviation.

The scientific novelty of the research lies in the fact that in this work, for the first time in the context of the established healthcare system, a study of the state of medical care for flight attendants was conducted; the level and dynamics of health status indicators of flight attendants were analyzed; the main trends of their somatic and gynecological morbidity depending on age and length of flight service were identified; clinical features of gynecological morbidity reflecting the nature of flight attendants' work were identified; their hormonal profile depending on length of flight service was studied; it was found that at a gynecological age of less than 5 years, violations of the menstrual-ovarian cycle are diagnosed; and, finally, practical recommendations for the improvement of medical care for flight attendants of civil aviation were developed.

The scientific and practical significance of the research lies in the fact that the analysis of the health status of one of the numerous professional groups — flight attendants — makes it possible to ensure targeted, timely identification of the main types of their pathology with due regard to age category and length of flight service, and to improve the system of preventive orientation. The practical recommendations proposed in the course of the research are aimed at the optimization of preliminary and periodic medical examinations of flight attendants, the improvement of the quality of the dispensary examination system.

The author's personal contribution consists in the selection of the research direction, the formulation of goals and objectives, their subsequent implementation, the generalization of the obtained results, and the preparation of scientific publications and reports on the dissertation topic. The materials of the work have been introduced into the educational process at the Department of Obstetrics and Gynecology of RMANO and at the Department of Public Health and Healthcare with a course in Economics of the Moscow Medical Academy named after I.M. Sechenov, as well as into the practical activities of the Central Clinical Hospital of Civil Aviation.

Based on the research materials, 7 printed works have been published, including 3 articles in journals recommended by the VAK RF.

Validation of the Dissertation Materials

The main materials of the dissertation were reported and discussed at: the VI International Scientific and Practical Conference "Health and Education in the XXI Century" (Moscow, December 8-10, 2005); the VII International Scientific and Practical Conference "Health and Education in the XXI Century" (Moscow, November 23-26, 2006);

- the All-Russian Forum "Health of the Nation is the Foundation of Russia's Prosperity" (Moscow, 2006);

- the I International Pirogov Student Scientific and Medical Conference "Modern Technologies in Obstetrics and Gynecology" (Moscow, April 14, 2006);

The main provisions of the dissertation work were reported and discussed on April 27, 2007, at the interdepartmental scientific conference of the departments of Public Health and Healthcare with a course in Economics of the Medical-Preventive Faculty of the Moscow Medical Academy named after I.M. Sechenov and the Department of Obstetrics and Gynecology of the Russian Academy of Postgraduate Education.

Main Propositions to be Defended:

1. At the beginning of their employment, flight attendants showed no exchange disorders or severe chronic pathology, but chronic diseases of the nervous system, digestive organs, and urogenital system were already present.

2. With the increase in length of flight service, age, and in connection with the specifics of the professional activity of flight attendants, their somatic and gynecological morbidity increases.

3. The clinical features of gynecological morbidity reflecting the nature of flight attendants' work are: disruption of the menstrual-ovarian cycle, hormonal profile, and characteristics of gynecological age.

4. The organization of medical care for flight attendants is influenced by their low medical activity and lack of motivation for preserving and strengthening their health.

Volume and Structure of the Dissertation

The dissertation is presented on 145 pages of typed text and consists of an introduction, five chapters, a conclusion, conclusions, practical recommendations, a list of references used (63 domestic and 35 foreign sources). The work is illustrated with 21 tables and 42 figures.