Organization of medical care for patients with gastric and duodenal ulcer – railway transport workers

The dissertation is devoted to the organisation of medical care for railway transport workers suffering from gastric and duodenal ulcer disease. The work examines the medico-social aspects of the disease, the role of occupational factors, and the features of its course in railway workers. The author develops a comprehensive system for the detection of patients using interactive medical testing, as well as algorithms for prevention, dispensary observation, and the selection of persons for work in railway transport.

The study is based on an analysis of data from the examination of railway transport workers with the use of interactive testing methods and on a study of the statistical characteristics of morbidity. The work presents principles of medical care for this category of patients, taking into account the specifics of their professional activity, aimed at preventing complications and strengthening the personnel potential of the industry.

Relevance of the problem.

Gastric and duodenal ulcer disease is one of the pressing problems of modern gastroenterology. Many aspects of this disease remain debatable to the present day. This concerns questions of aetiology and pathogenesis, prevalence among different age groups, as well as features of the course depending on sex, age, profession, social status of the patients, localisation of ulcer defects, etc. [5, 12, 21, 25, 47, 53, 54, 73, 83, 93, 100, 135, 153, 166, 167, 171, 178, 206, 225, 227]. The question of the unity of the pathogenesis of gastric and duodenal ulcer disease is also debatable. Far from all of the currently proposed methods of treatment of the disease ensure rapid and complete restoration of structure and function, not to mention cure and prevention of relapses; a protracted course of ulcer disease is not uncommon [89, 90, 92, 104, 140, 184, 192]. Ulcer disease is becoming increasingly widespread among persons of working, active age [130, 134]. The prevalence of ulcer disease amounts to between 2 and 10% among the adult population, and there is a clear tendency towards an increase in morbidity [172, 179]. The frequency of annual relapses reaches 30-82% [132]. Cases have become more frequent in which ulcer disease debuts with complicated forms in persons not previously registered [144, 151]. The percentage of severe, constantly relapsing course is high, and such formidable complications as perforation and haemorrhage are not uncommon [91, 114]. This is due primarily to the fact that the diagnosis of ulcer disease at an early stage is difficult, and moreover insufficient attention is given to it. In this connection, questions of treatment, prevention, and dispensary observation of this category of patients are also far from being resolved [22].

In recent years, increased interest has been noted in the features of the course of ulcer disease depending on the social status of patients, in particular among persons whose work is connected with constant psychoemotional strain or occupationally conditioned disturbances of dietary regimen (drivers, dispatchers, pilots, etc.). The tendency towards an increase in the morbidity of ulcer disease is also preserved in the group of persons employed in railway transport [11, 151]. This applies both to those directly connected with the movement of trains (locomotive crew drivers) and to other categories of railway workers (ticket clerks, track workers, etc.).

Unfortunately, effective methods of detecting ulcer disease in the examination of large numbers of people have still not been developed. In particular, in conducting planned dispensary examinations, which railway workers undergo on a mandatory basis, a formal approach to this task is observed for objective reasons. First and foremost, this is connected with the limited amount of time allotted to the physician for the examination of a single patient [75]. At times there is the patient's unwillingness to make contact with the physician because of fear of losing work as a result of the detection in him of some disease.

All of this renders the problem of timely detection of ulcer disease in persons employed in railway transport socially significant and requires the search for new effective, accessible methods of objective study of the health of this social group, which is necessary from the point of view of detecting initial manifestations of unfavourable shifts in its level [28, 75, 151].

The aim of the work was the development of a comprehensive system for the detection of railway transport workers with gastric and duodenal ulcer disease, and the creation of an algorithm of medical care for railway workers suffering from this disease.

The aim set determined the following tasks:

1. To evaluate the detectability and prevalence of gastric and duodenal ulcer disease among railway transport workers.

2. To develop methods for the preventive detection of ulcer disease in railway workers during planned medical examinations using interactive testing methods.

3. To develop a system for the prevention of ulcer disease and its exacerbations in railway transport workers, taking into account the specifics of the profession, aimed at the prevention of possible complications.

4. To develop and introduce a method for improving the selection of persons for work in railway transport with the aid of interactive testing methods.

Scientific novelty.

For the first time, in the conditions of the system of institutions of the Health Department of the Ministry of Railways of the Russian Federation, a methodology of interactive testing has been developed and introduced. An algorithm for the individual detection of gastric and duodenal ulcer disease has been proposed. The detectability and prevalence of gastric and duodenal ulcer disease in railway workers have been studied using interactive research methods.

Main propositions of the dissertation submitted for defence.

1. Among railway workers the prevalence of gastric and duodenal ulcer disease exceeds the general average statistical indicators for the majority of the population of working age.

2. The socio-hygienic characteristics of the disease in patients with gastric and duodenal ulcer disease working in railway transport have their own features.

3. The developed system of interactive testing is characterised by high effectiveness in the detection of gastric and duodenal ulcer disease, contributes to improvement of the prognosis of the disease, and prevention of possible complications.

4. The methodology of interactive testing developed and introduced into practice is a new progressive form of improvement of health protection of railway workers and strengthening of the personnel potential of the industry.

Practical significance.

The proposed interactive methods of medical testing of railway transport workers make it possible with high accuracy to forecast the individual risk of the occurrence of gastric and duodenal ulcer disease and its complications.

These methods, by virtue of their simplicity of execution, practically have no limitations on use, are accessible to a wide circle of examined persons regardless of their educational level, and can be used throughout the network of healthcare institutions of the system of the Ministry of Railways of the Russian Federation.

Volume and structure of the dissertation.

The dissertation is written in the Russian language, set out on 133 pages of typewritten text, and consists of an introduction, a review of the literature, 3 chapters of original research, a conclusion, conclusions, practical recommendations, and a bibliographic index comprising 235 works (of which 173 are domestic). The work contains 12 tables and is illustrated with 39 figures.