Scientific Justification of Organizational Forms of Prevention of Obstetric and Gynecological Pathology Among Women Employees of Urban Electric Transport

The dissertation is devoted to the scientific justification of organizational forms of prevention of obstetric and gynecological pathology among women employees of urban electric transport. A complex of medical-social and hygienic risk factors is investigated, formed under the impact of the production environment, the peculiarities of labor activity, and the lifestyle of women-drivers and workers of planned preventive repair. A comprehensive program of clinical-statistical and medical-social study of reproductive health of this category of women has been developed and implemented, including an analysis of morbidity, a medical-sociological survey, and a probabilistic-prognostic assessment of the influence of risk factors. Special attention is given to the determination of priority occupational and non-production factors exerting a negative impact on reproductive function, as well as to the justification of systematic measures for the preservation of health and the improvement of obstetric and gynecological care for women employees of urban electric transport.

Relevance of the problem. In the "Concept of Reproductive Health Protection of the Population of the Russian Federation for the Period 2000–2004," the joint decision of the Collegium of the Ministry of Health, the Ministry of Labor, and the Ministry of Education of the Russian Federation (2000) identified as one of the main tasks the necessity of increasing the volume of preventive measures. The conceptual basis for solving this task is the identification and prevention of reproductive disorders associated with the impact of harmful factors of the environmental and production environment (Aylamazyan E.K., 1998; Vasilyeva T.P., 1999; Posiseeva L.I.B., 1999; Poznanskaya A.V., 1999; Krotin P.N., 2000; Sharapova O.V., 2001; Sivochalova O.V., Denisov E.I., Chashchin V.P., Frolova N.M., Kurlyandsky B.A., 2002, etc.). Despite the fact that the occurrence of reproductive health disorders resulting from the impact of harmful factors of the production environment on the body is widely represented in domestic and foreign literature, the scientific foundations for assessing the risk of these disorders and their primary prevention remain one of the least developed problems of public health and health care, hygiene, obstetrics, and gynecology (Sivochalova O.V., 2001; Shapkayts V.A., 2001; Ovcharov V.K., 2001; Orel V.I., 2001; Izmerov N.F., 2002; Bezhenar V.F., 2002; Yuryev V.K., 2002, etc.).

An important principle of the effective use of labor resources is the involvement of women in industrial production and professions that most fully correspond to the anatomo-physiological and psychological peculiarities of the female organism and do not cause harm to health, especially motherhood (Izmerov N.F., 1985, 1996; Sheparev A.A., 1998; Saprykina A.G., 1999; Shabarkina N.I., 2001; Artamonova V.G., 2001; Shapkayts V.A., 2000; Suslopolov L.I.A., 2001; Kostyuk D.F., 2002; Aylamazyan E.K., 2003, etc.).

Contemporary legislation, the transition to a market economy, and the introduction of new forms of medical-social insurance impose the necessity of justifying new organizational forms of functioning of medical institutions serving industrial enterprises and of developing medical-preventive health programs (Shchepin O.P., 1995, 2000; Denisov I.N., 1997; Ovcharov V.K., 1997; Polyanov I.V., 1998; Kicha D.I., 1999; Starodubov V.I., Mikhailova Yu.V., 2000; Vishnyakov N.I., 2001; Medik V.A., 2003; Yuryev V.K., 2003; Kuchenko V.Z., 2003, etc.).

Scientific research of recent years indicate that women working in urban electric transport are subjected to a combined impact of a number of occupational, environmental, and domestic factors exerting a negative influence on the state of health of women and their specific functions (Retnev V.M., 1998; Ignatyuk A.N., 1999; Darmogray N.V., 1999; Ushakova L.V., 1999; Simina E.E., 2000; Suslopolov L.I.A., 2001; Luckevich V.S., 2002; Posazhennikov A.P., 2002; Fenina A.N., 2003, etc.).

However, to date, there is no scientific justification of organizational forms of medical-social and preventive provision of women working in the system of urban electric transport. The interrelationships and the strength of influence of risk factors of labor activity and lifestyle of women-drivers and workers of planned preventive repair have not been determined. An important task remains the determination of the degree of reproductive risk, which would allow the prevention and reduction of levels of occupational morbidity and the enhancement of the effectiveness of health programs.

The goal of the research — is the medical-social and clinical-statistical assessment of risk factors and the justification of organizational forms of prevention of obstetric and gynecological pathology among women employees of urban electric transport.

Research tasks:

• to present a medical-social and hygienic assessment of the influence of risk factors of labor activity on the health of women-drivers and workers of planned preventive repair;

• to conduct a medical-social and clinical-statistical analysis of morbidity and obstetric and gynecological pathology;

• on the basis of medical-sociological pre-diagnostic diagnosis and screening questionnaire surveys, to present a socio-hygienic analysis of risk factors of obstetric and gynecological pathology and a probabilistic-prognostic assessment of their influence;

• to determine the need of women employees of urban electric transport for various types of medical care and for the conduct of systematic therapeutic and preventive measures;

• to justify systematic therapeutic-organizational and medical-preventive measures for the preservation of reproductive health and the improvement of obstetric and gynecological care for workers of urban electric transport.

The scientific novelty of the research consists in the fact that for the first time a comprehensive program of medical-social and clinical-statistical study of risk factors in the formation of obstetric and gynecological pathology among women employees of urban electric transport has been developed. The priority of hygienic risk factors of labor activity of women-drivers of electric transport and workers of planned preventive repair and their influence on the reproductive function have been determined. An assessment of women's health has been given based on the analysis of morbidity with temporary loss of work capacity, in-depth medical examinations, and medical-sociological pre-diagnostic diagnosis. For the first time, results of a medical-sociological study of non-production activity, features of lifestyle, medical awareness, and medical-preventive activity have been presented. Risk groups of working women have been identified and determined. The features of family planning among working women have been studied. For the first time, probabilistic-prognostic indicators of the influence of risk factors on the formation of obstetric and gynecological pathology have been calculated. An analysis of women's need for various types of medical care has been presented. Systematic therapeutic-organizational and medical-preventive measures for the preservation of reproductive health and the improvement of obstetric and gynecological care for women employees of urban electric transport have been justified.

The practical significance of the work is determined by the results of the research, which make it possible to identify groups of medical-social and hygienic risk among women working in the system of urban electric transport. The identified patterns provide the possibility of determining priority measures for primary and secondary prevention of obstetric and gynecological pathology, improving the system of hygienic supervision and shop-level medical-social provision. Of practical interest is the developed algorithm for assessing the informativeness of risk factors of the main types of activity, which allow forecasting changes in reproductive health, implementing a program for coordinating the activities of the medical-sanitary department, centers of state sanitary-epidemiological surveillance, and other institutions interested in optimizing medical-social provision and strengthening the health of women employees of urban electric transport. Of practical importance are the results of the medical-social and clinical-statistical analysis of morbidity and obstetric and gynecological pathology, which can be used by medical workers of the medical-sanitary department and women's clinics to determine the need for systematic therapeutic and preventive measures, to ensure accessibility, and to improve the quality of medical care.

The materials of the dissertation research have been introduced into the practical activity of health care bodies and institutions of Saint Petersburg, presented in the methodological recommendations "Methods for Assessing Population Reproductive Health Disorders in Connection with Environmental Factors Exerting Harmful Effects on Humans," approved by the Ministry of Health of the Russian Federation (2001), and in "Hygienic Assessment of Harmful Production Factors and Production Processes Hazardous to Human Reproductive Health," approved by the State Sanitary-Epidemiological Service of the Ministry of Health of the Russian Federation (2002), as well as in the methodological recommendations "Organizational and Clinical Forms of Improvement of Obstetric and Gynecological Care for Women Employees of Urban Electric Transport," approved by the Committee on Health of the Administration of Saint Petersburg, in a methodological manual for physicians (2001) and in a textbook for students of departments of public health and health care of medical universities (2002), approved by the Accreditation Methods Commission of the Ministry of Health of the Russian Federation, used in the training of students at departments of public health and health care, hygiene of production and the environment, and obstetrics and gynecology of Saint Petersburg State Medical Academy named after I.I. Mechnikov. The main provisions have been published in 20 scientific works.

Presentation and discussion of research materials. The results of the research and the main provisions of the dissertation were presented and discussed at:

• the International Congress "Human Biometeorology" (Saint Petersburg, 2000);

• the 5th International Conference "Ecology and Development of the Baltic Region" (Kronstadt-Finland, 2000);

• the 6th International Conference "Ecology and Development of Northwest Russia" (Saint Petersburg, 2001);

• the regional scientific-practical conference "Actual Problems of Sanitary-Epidemiological Well-Being of the Population of the Northwest Region" (Saint Petersburg, 2000);

• the scientific-practical conference of Saint Petersburg State Medical Academy named after I.I. Mechnikov "Public Health and Health Care" (Saint Petersburg, 2002);

• scientific-practical conferences of young scientists of Saint Petersburg State Medical Academy named after I.I. Mechnikov (Saint Petersburg, 2000–2002).

Personal contribution of the author. The author developed the program and conducted the medical-social and clinical-statistical research. The collection of scientific information was carried out by transcribing data from primary medical documentation of the medical-sanitary department. The author participated in hygienic examinations of the workplaces of drivers and workers of planned preventive repair, took part in conducting clinical examinations of women employees of urban electric transport (together with other specialists, as reflected in joint publications and references in the corresponding sections of the work). A medical-sociological survey of women and screening questionnaire survey were conducted. A clinical-statistical and medical-social analysis of the influence of risk factors of labor and non-production activity on the formation of obstetric and gynecological pathology was carried out. Organizational forms of therapeutic and preventive measures for the preservation of reproductive health of women were justified. The author carried out planning, generalization, and medical-social and clinical-statistical analysis of the results (the author's share in the accumulation and analysis of materials was up to 100.0%, in mathematical-statistical processing more than 80.0%).

Main provisions to be defended:

1. Results of the medical-social and clinical-statistical assessment of risk factors in the formation of morbidity and obstetric and gynecological pathology among workers of urban electric transport. Among the examined women, a significant risk group was established in terms of labor activity, living conditions, level of medical awareness, and preventive activity.

2. Data on morbidity and indicators of reproductive health of the examined women. The compiled correlation matrix and probabilistic-prognostic assessment made it possible to determine the priority and weighted significance of occupational and non-production risk factors in the formation of various nosological forms of diseases (including diseases of the female pelvic organs).

3. Results of medical-sociological pre-diagnostic diagnosis and screening questionnaire surveys. Specific features of gynecological pathology were identified. A high need for additional types of medical care and for primary and secondary preventive measures was determined.

4. Systematic therapeutic-organizational and medical-preventive measures for the preservation of reproductive health and the improvement of obstetric and gynecological care for women employees of urban electric transport. Taking into account the identified specific disorders of reproductive health and the formation of risk groups, the following were proposed: therapeutic and health-improving programs; measures to raise the level of medical awareness; rational employment with the development of criteria for occupational fitness; the introduction of additional structures in the medical-sanitary department; new sections and forms of accounting documentation; additional medical-preventive and medical-genetic counseling; socio-psychological correction; and measures to increase the effectiveness of state sanitary-epidemiological surveillance, among others.

Structure and volume of the dissertation. The dissertation consists of an introduction, a literature review, a program, methodology, and organization of research, 3 chapters, a conclusion, conclusions, practical recommendations, a list of references, appendices and documents confirming the introduction of the obtained results into practice. The research contains 33 tables and 11 figures. The text of the dissertation is presented on 161 pages. The list of references includes 414 sources (including 147 foreign).