Environment&Health (Dovkillia ta zdorovia)

13-21

Authors: Нагорна А.М., Савенкова Н.В.

Introduction: In recent years, there has been a gradual decline in occupational traumatism in Ukraine, but an in-depth analysis of the data shows that statistics does not fully reveal the complexity of the current situation on occupational traumatism and the quality of its registration and record-keeping, especially in case of sudden death at a workplace. According to the Resolution of the Cabinet of Ministers of April 17, 2019 № 337 on «Procedure for investigation and record-keeping of the incidents, occupational diseases, and accidents at the production» (with changes made in accordance with the Resolution of the Cabinet of Ministers № 1, 05.01.2021) the amendments were made where the circumstances of an accident and / or acute occupational disease (poisoning), cases of sudden death were recognized as related to production (according to the Article 52, paragraphs 6-8). Objective: We identified the regularities of the formation of the indicators of natural death at workplace of the employees over 2015-2020 in Ukraine. Materials and methods: According to the data of the State Statistics Committee of Ukraine and the State Labour Service of Ukraine, we performed the analysis of natural deaths of the employees at workplace in the dynamics of monitoring by the types of economic activity, occupations and causes over 2015-2020 and established the ways for the improvement of their record-keeping. Statistical data were evaluated with the help of rankings, methods of generally accepted statistical analysis. Results and discussion: From 2015 to 2019, the number of the accidents at production, registered and recognized as insured events, decreased from 4,260 to 3,876 (by 9.0%), and the number of the fatal traumatized increased from 375 to 422 (by 11.1%). In 2020, the number of the accidents (A) increased up to 6121 (by 30.4%), and the accidents with fatal consequences increased up to 653 (by 42.5%), mainly due to the diseases of circulatory system and COVID-19. In recent years, there has been an increase in sudden deaths (SD) and «rejuvenation» of the contingent of working people.The problem of natural death is actual worldwide and according to the WHO, makes up 5-7%. Among those who died of natural causes, young people aged 20-39 years make up a significant proportion, mainly due to circulatory diseases and COVID-19. It was established that in the dynamics of 2015-2020, there were 4861 cases of natural death (ND) at workplace in Ukraine, which are 8.0-16.2 per 100 thousand working population and 27.2-55.0 per 100 thousand population working under harmful working conditions against 5.3 and 14.1 in 2012. The analysis of cases of ND in terms of gender, age and length of service shows that more than 77.0% are men aged 20-60 years old. The distribution of cases of ND at the workplace in Ukraine by the branches of industry shows that the socio-cultural sphere (30.0-55.2%), transport (16%), engineering and metallurgy (10.5-6.6%), coal and mining industry (4.2-2.4%) are the main ones. The cases of ND at workplaces from diseases of the circulatory system in the employees of social sphere and transport, miners of coal mines have been analyzed in details. The methods of prevention of ND at workplace are proposed. Conclusions: 1. The problem of natural death at the workplace requires an additional legislation to determine the circumstances of death connected with the working conditions or the feautures of the production process. 2. The most frequent cases of ND at the workplace in Ukraine are registered among employees of the socio-cultural sphere (30.0-55.2%), transport (16%), mechanical engineering and metallurgical industry (10.5-6.6%), construction and road construction, agro-industrial complex , coal and mining industry (4.2-2.4%). 3. Diseases of the circulatory system (acute cardiovascular failure (heart attack, stroke), coronary heart disease, heart and lung failure on the background of nervous and emotional stress, lack of sleep, the presence of a complex work schedule (daily, 12 hours, night shifts, which requires a separate study of causation) and impact of the adverse factors of the working environment were the main causes of ND in the employees. 4. Prevention of ND is in the field of the restoration of the system of providing medical care to employees, improvement of the quality of preventive medical examinations, pre-shift control, occupational selection.

30-37

Authors: Bandazhevskyi Yu.I., Dubova N.F.

Оbjective: The aim of the study was to identify interrelations between the state of folate cycle genetic apparatus and blood levels of homocysteine, thyroid and adenohypophysis hormones in the blood among the children from Ivankivskyi and Poliskyi districts, Kyiv region, bordering the Chornobyl exclusion zone (СhEZ). Methods: Immunochemical, genetic, statistical ones. Results: We measured blood levels of homocysteine (Hcy), pituitary thyroid-stimulating hormone (TSH), free triiodothyronine (T3), free thyroxine (T4) in 158 children from Poliskyi district and 178 children from Ivankivskyi district and assessed the state of a genetic system of the folate cycle (FC). The average age of the examined was (15.2 ± 0.9) years old (95% CI 15.0-15.4 years old). Taking into account the FC genotypes, genetic subgroups were formed, they were based on 100% representation of one specific genotype. The laboratory examination was carried out twice: in April and December 2015 (before and after the fires in the ChEZ). It was found out that in the total group of the children, as well as in most of analyzed genetic subgroups, the level of Hcy and thyroid hormones (TG) in the children from Ivankivskyi district was statistically significantly higher than in those from Poliskyi district. At the same time, a direct association between Hcy and TSH was observed in the total group, as well as in most of the genetic subgroups of children from Ivankivskyi district, and this ssociation was absent in the children from Poliskyi district. The blood level of Hcy both in the children from Poliskyi district and in the children from Ivankivskyi district was statistically significantly higher in the subgroup containing only homozygous variants of the T allele of the MTHFR:677 genetic polymorphism in comparison with the subgroups containing neutral C alleles of the same polymorphism. At the same time, there were no differences for TSH, T3 and T4. Сonclusions: The analysis enabled to establish a synchronous reaction of metabolic cycles ensuring the metabolism of Hcy and thyroid hormones in the adolescents, regardless of the FC genotypes. Correlation analysis, as well as the results of statistical analysis, indicate that an increase in the level of Hcy in the blood of children induced the synthesis of TSH and T3. The results show a close relationship between thyroid hormone genesis and the metabolism of methionine sulfur-containing amino acids and Hcy. A forest fire, containing long-lived radioactive elements, is the most likely reason for the increase of Hcy level and, as a result, the hormones of the pituitary-thyroid axis in the blood of the children living in the districts, bordering the ChEZ.

44-48

Authors: Думанський В.Ю.1 Козярін І.П., Івахно О.П.

Objective: We performed the eco-hygienic assessment of electromagnetic fields as an environmental factor under modern conditions. Materials and methods: We determined a range of issues on the significance of electromagnetic fields of various frequencies and intensities in human vital activity on the basis of the analysis of scientific literature. Results and discussion: Taking into account the further development of the national economy of the country, safety and protection of the population from the effects of electromagnetic fields both in industry and everyday life remain one of the urgent problems, taking into consideration that their biological effect on the human organism is very complex and has not been completely studied. In this regard, special attention should be paid to the use of hand-held telephones and computers which are used by the people of different age, gender and physiological state of the organism. Therefore, the existing protection measures against the negative effect of EMF require further improvement and refinement. Conclusions: Protection of the population from the adverse effects of electromagnetic radiation of various frequencies and intensities has been and remains an urgent eco-hygienic problem of mankind, and medical workers, engineers, biologists, ecologists and other specialists should participate in its solution.

56-63

Authors: Яворовський О.П., Скалецький Ю.М., Брухно Р.П., Риган М.М., Зінченко Т.О., Таран Н.В.

Objective: We identified the main occupational hazards in the hospital environment and determined their role in the formation of the safety of medical personnel at healthcare institutions. Materials and methods: We applied the bibliosemantic, questionnaire, hygienic and statistical research methods. Results: In the course of the labour activity at the health care institutions (HCI), the medical workers are exposed to the risk of negative effects of biological, psychophysiological, chemical, physical and social harmful and dangerous factors. The biological and psychophysiological factors are the most harmful factors. The adverse occupational factors of the hospital environment do not have an isolated effect, but have a complex, combined and joint effect, and their priority varies depending on the specificity of medical speciality. Under conditions of COVID-19 pandemic, the risk of the negative impact of production environment factors on the medical personnel at the HCI has been increased. In particular, the risk of infection with pathogens of infectious diseases increases, the work load, psycho-emotional tension, the duration of the use of personal protective equipment and the frequency of contact with the disinfectant solutions increase, the probability of violence, harassment, stigmatization, and discrimination related to the professional affiliation of health care personnel increases. The lack of a safety culture is one of the most important mechanisms for launching and realizing the dangers of a hospital environment, and just a creation of positive practice of a safety culture at work can significantly reduce the risks of realizing potential hazards that exist at health care institutions. Conclusion: The identification of the dangers of the hospital environment with the formation of a comprehensive understanding of their importance for the ensurance of the safety for medical personnel is an urgent task for modern medical science and will make it possible to develop reasonably the measures aimed at the ensurance of the safety of the hospital environment in terms of the safety of medical personnel.

71-73

Authors: Яворовський О.П., Парій В.Д., Шуляренко В.П., Шуляренко І.Ф.

На прикладі життя і наукової діяльності Уваренка А.Р. висвітлю- ються етапи становлення і розвитку у незалежній Україні соціаль- ної гігієни та управління охорони здоров’я, формування центру науково-медичної інформації та патентно-ліцензійної роботи і створення менеджменту охорони здоров’я, наукові підвалини яких закладалися за його найактивнішої участі.

76-77

Authors: Яворовський О.П.

Рецензія на монографію Махнюк В. М., Сердюка Є. А., Чорної В. В., Гаркавого С. С., Лаптєва В. Е. за загальною редакцією академіка НАМН України Сердюка А. М. та редакцією член-кореспондента НАМН України Польки Н. С.

15-22

Authors: ОМЕЛЬЧЕНКО Е.М., ПОЛЬКА О.О., ЄЛІЗАРОВА О.Т., КАРТАШОВА С.С.

Smoking is at one of the first places among the factors of lifestyle that negatively affect human health, including indicators of the respiratory, reproductive, digestive and cardiovascular systems. A relationship between smoking and morbidity, prevalence and mortality from cardiovascular diseases (CVD), taking into account the age structure of the Ukrainian population, was a subject of the study. These diseases were selected as an indicator of the negative effects of smoking. Objective: We identified the trends in the variability of cardiovascular pathology among the population under the influence of both active and passive smoking, established the degree of relationship between these indicators and assessed «cause-effect» relationships as well. Materials and methods: The data analysis was performed on the basis of the official state statistics and own retrospective genetic monitoring data. Results: In Ukraine, since 2009, current legislation significantly restricts smoking in public places. Due to the reduction of smoking intensity, the above measures were expected to lead to a reduction in the incidence (mortality) from CVD during a long period after the enactment of legislative changes. The share of smokers in Ukraine (age 12+) for the period 2013-2016 is lower by 17.4% (t=4.6; p<0.01) than for the period 2004-2012. The share of the smokers in Ukraine (age 12+) for the period 2013-2016 is lower by 17.4% (t=4.6; p<0.01) than for the period 2004-2012. At the same time, there was a decrease in the proportion of those who smoke 1-5 or more 20 cigarettes a day. From 2009 to 2016, the incidence of CVD decreased by 23%, and the mortality rate from CVD decreased by 9%. This decrease was due both to a decrease in the number of smokers (almost by 32%) and to a decrease in cigarette sales (at least by 39%). The relationship between a decrease in the proportion of smokers in the population and a decrease in morbidity and mortality from cardiovascular disease (p<0.05) has been established. Conclusions: The enactment of the Law of Ukraine on Tobacco Control had a positive systemic effect, its impact affected the reduction of morbidity and mortality of the population of Ukraine from cardiovascular diseases, which significantly improved the demographic situation.

28-35

Authors: BANDAZHEVSKYI YU.I., DUBOVA N.F.

Objective: We compared thecontent of homocysteine, hormones and minerals of the blood in the children with different levels of physical development living in the settlements near Chornobyl exclusion zone. Methods: We used instrumental, laboratory, mathematical and statistical methods in the study. Results: 158 children (78 boys and 80 girls) from Polisskyi district, Kyiv oblast were examined within the projectsof the European Commission in Ukraine «Health and Ecological Programmes Connected with Chornobyl Exclusion Zone: Development, Training and Coordination of Health-Related Projects» and Rhône-Alpes Regional Council (France). The studied territory has remained contaminated with radioactive substances after Chornobyl accident until the present day. 137Cs incorporation was shown to affect negatively the physical development (PD) of the children. 137Cs radionuclides cause the disorders of cellular energy, affect negatively thyroid hormone genesis.A significantly high level of free triiodothyronine (T3), parathyroid hormone (PTH) and P was established in adolescents with abnormal low PD in comparison with the children with abnormal high PD. Correlations between the indices of PD, endocrine system and mineral metabolism, registered in a group of examined children, reflect the physiological response of the organism to the cell damage associated with an exposure to 137Cs radionuclides. Comparison of the values of separate metabolic indices with the reference values does not always reflect objectively the severity of metabolic disorders. To identify the metabolic disorders under conditions of constant incorporation of 137Cs radionuclides in a child’s organism, it is necessary to use the information on the associations among several metabolic indices in a group of children living in the territory suffered from the accident at Chornobyl nuclear power plant.

44-55

Authors: ЧЕРНИЧЕНКО І.О., БАЛЕНКО Н.В, ЛИТВИЧЕНКО О.М., БАБІЙ В.Ф., ГЛАВАЧЕК Д.О., КОНДРАТЕНКО О.Є.

Objective: We determined the possible effects of priority chemical environmental carcinogens on the incidence of hormone-dependent tumors and the mechanisms of their effect on the basis of the analysis of literature data and our own research. Results: The performed analysis demonstrates the scanity of the research devoted to the study of chemical carcinogens which are concerned only with the class of polycyclic aromatic hydrocarbons (PAH), benzo(a)pyrene (BP), atmospheric pollution, emissions from vehicles, the cadmium heavy metal and products of smoking containing these substances. The connection with PAH (BP) and the development of breast, ovarian cancer, cadmium with the development of breast, endometrial, ovarian cancer in women and prostate cancer in men was established. Epidemiological data, combined with experimental ones, suggest a possible contribution of carcinogens into the increase of the incidence of hormone-dependent tumors. At the same time, mechanisms of action of PAH and cadmium on the development of hormone-dependent tumors are unclear. The accumulated experimental and epidemiological data allow us to conclude that the oncological danger of these carcinogens lies in the combination of genotoxic and hormone-mimetic properties; the main mechanisms, involved in the realization of the effect of BP and cadmium, are associated with changes and disorders at different levels of the structural and functional organization of the organism, including the endocrine system, which can lead to the development of tumors. The urgency of the problem of the incidence of hormone-dependent tumors and the potential role of the studied chemical carcinogens as pollutants of the environment of human functions indicate the need to take these circumstances into account when developing and implementing preventive measures.

62-71

Authors: МАХНЮК В.М., ЧАЙКА Г.В., ЧОРНА В.В., ВОЛОЩУК О.В., МЕЛЬНИЧЕНКО С.О., ПЕЛЕХ Л.В.

Background: Health care facilities located in built-in non-residential premises of residential buildings are medical institutions of a new type. There are no sanitary-and-hygienic requirements for their placement in the Ukrainian legislation for them. The above was a basis for the conduction of the comprehensive hygienic research on this issue using the T. Saati method. Objective: We performed an expert assessment of the impact of architectural planning decisions and maintenance conditions of health care facilities built into residential buildings on the medical workers’ feel and the conditions of the stay of visitors and residents by means of the in pair comparison of hierarchies (the T. Saati method). Materials and methods: In our study we used the materials of the research on the architectural-and-planning decisions on the location and maintenance of built-in residential buildings of health care institutions which were a subject for expert assessment by the T. Saati method. Conclusions: According to the results of the research, the changes into the regulatory framework of urban planning legislation - SBSB.2.2-10-2001 «Health Care Facilities» on the standardization of the special purpose area for temporary mini-parking, built-in health care institutions for medical workers and visitors were substantiated.

14-19

Authors: ЛИПОВЕЦЬКА О.Б., ПРОКОПОВ В.О., АНТОМОНОВ М.Ю.

Objective: We developed the simplified formulas for the calculation of carcinogenic risk in case of inhalation and cutaneous entry of drinking water chloroform into the human body. Materials and methods: We calculated average daily lifetime doses for the oral, inhalation and cutaneous entry of drinking water chloroform into the human body according to the R.2.1.10.1920-04 and MU 2.2.4-122-2005. The calculation of carcinogenic risks was carried out taking into account the average daily entry of a chemical substance throughout life and the slope factor. Mathematical calculations were performed with the help of the STATISTICA 10 portable software package. Results: In the calculation of the carcinogenic risks, the formulas for the determination of the average daily dose for the inhalation and cutaneous routes of entry of carcinogen into the human body are more complex in comparison with the oral route with additional calculations, reference values, coefficients, etc. Therefore, we have developed a simplified method for its assessment. Linear regression models were chosen to describe the dependence of the carcinogenic risk in the inhalation and cutaneous routes of entry on the concentration of chloroform in water. Evaluation of the results obtained by the values of the correlation coefficients (R, RI), Fisher's criterion (F, pF), and errors of the coefficients (p) showed that both models were adequate to the initial data with a very high degree of reliability. Conclusions: As a result of the study, the solutions of the problem of the assessment of the carcinogenic health risk from the entry of chloroform with drinking water by inhalation and cutaneous routes were obtained with the help of simplified mathematical formulas of linear dependence. The advantage of the proposed solution method is a speed and ease of getting value of the individual carcinogenic risk for the population of various cities of Ukraine for each route of entry, based on the chloroform content in drinking water. This will make it possible to apply risk assessment for a comparative assessment of the impact of chloroform in drinking water at different territories, in different periods of time before and after preventive measures, to compare the effectiveness of the introduction of new technological processes and equipment, etc.

29-35

Authors: БАНДАЖЕВСЬКИЙ Ю.І., ДУБОВА Н.Ф.

The aim of this paper was to assess the prevalence of the T risk allele of the MTHFR:677 genetic polymorphism in a group of girls from Ivankovsky and Polessky districts located near the Chernobyl exclusion zone. In addition, we assessed variants of combined carriership of the T allele with risk alleles of other genetic polymorphisms regulating the folate cycle. Research methods. Immunochemical, statistical. Results. Genetic predisposition to breast cancer risk was analyzed in a group of 251 adolescent girls. Carriership of the T allele of the MTHFR:С677Т polymorphism was found in 142 children (56.6%), while the homozygous T/T variant was found in 25 girls, or in 10.0% of cases. Compound heterozygosity for the 677CT/1298AC alleles of the MTHFR gene was recorded in 60 individuals, or in 23.9% of cases. Conclusions. The revealed genetic changes in the folate cycle lead to a significant decrease in the activity of methylenetetrahydrofolate reductase, and, accordingly, to an increase in the level of homocysteine in the blood, creating conditions for the occurrence of breast cancer. Given the high level of genetic predisposition, taking into account the constant impact on the body of radioactive elements and their decay products, the occurrence, as a consequence, of serious metabolic disorders, it is necessary to identify the breast cancer risk group of children.

42-48

Authors: РУБЦОВ Р.В.

Objective:We studied the efficiency of the comprehensive treatment of ore mining and iron and steel industry workers having the pneumoconiosis combined with chronic obstructive pulmonary disease in terms of intoxication indicators as an assessment of measures aimed at treatment and prevention of this occupational pulmonary pathology. Results: It was established that conducted treatment in the patients, ore mining and iron and steel industry workers with the use of bronchodilator, mucoregulator, anti-inflammatory agent of a complex vitamin medication, as well as sessions of hyperbaric oxygenation at 1.3 atm led to a decrease in the activity of inflammation processes with regard to the content in the peripheral blood of the total number of leukocytes, their stab and segmented subpopulations, and a decrease in most intoxication indices: the leukocytic index of intoxication, the granulocytic-agranulocytic index, the general index of intoxication, the sinistroposition index, the index of the ratio of leukocytes to erythrocyte sedimentation rate, which indicates a decrease in the systemic inflammation activity with the simultaneous suppression of intoxication phenomena. In comparison with the patients with other occupational lung pathology, the comprehensive treatment led to a more significant decrease in the content of segmented and stab leukocytes, as well as the main integral intoxication indices: the leukocytic index of intoxication, the granulocytic-agranulocytic index, and the general index. Thus, the comprehensive treatment of ore mining and iron and steel industry workers having the pneumoconiosis combined with the chronic obstructive pulmonary disease is an important link in the system of measures aimed at treatment and prevention ofthis occupational pulmonary pathology. Conclusions: In the ore mining and iron and steel industry workers having the pneumoconiosis combined with the chronic obstructive pulmonary disease,the comprehensive treatment with the use of bronchodilator, mucoregulator, nebulizer-administered anti-inflammatory agent, a complex vitamin B medication administered intramuscularly, as well as sessions of hyperbaric oxygenation led to an improvement in some inflammation indicators and intoxication indices which is a predictor of a positive course of the disease. The assessment of the results of the conducted comprehensive treatment of the workers indicates a significant positive dynamics of intoxication processes and makes it possible to regard this treatment as an important link in the system of measures aimed at treatment and preventionofthisoccupational pulmonary disease.

60-65

Authors: ГОЛІЧЕНКОВ О.М., ДОМАРАЦЬКА Ю.С., ГРИГОРЕНКО Л.Є., СТЕПАНЧУК С.В. ЛЯШЕНКО В.І., МАЙСТРЕНКО З.Ю.

Objective: We evaluated the sensitizing effect of various detergents intended for the care of dishes and other products for children. Materials and methods: The study was carried out in guinea pigs. The sensitization of the animal’s organism was studied in the reaction of degranulation of peripheral blood basophils (after Shelley). Forthestudy, we selected 10% solutions of domestic and foreign products for washing children's dishes ("Alionka", "Karapuz", "Ushastyi Nian", "Frosch Baby") purchased in the supermarkets of Kyiv. Results: In 21 days, the performed study made it possible to establish the development of sensitization of the organism of the animals in the experimental groups exposed to the solutions of the detergents "Alionka", "Karapuz", "Ushasty Nian” for washing children's dishes, although the degree of its manifestation was different. The solution of the detergent "Ushastyi Nian" was shown to possess more pronounced sensitizing properties, as evidenced by the development of weak positive autosensitization and positive sensitization of the organism of the experimental animals. The impact of the detergents for cleaning children's products "Alionka" and "Karapuz"on the animals’ organism leads to the development of mild sensitization, and when using the solution of "Alionka" detergent, a development of the weakly expressed autosensitization of the organism is also observed in the animals. There was no increase in the degranulation of basophilic granulocytes in the presence of both tissue antigen and hapten in the group of animals where the solution of detergent "Frosh Baby" was used, which indicated the absence of auto- and sensitization of the organism of the animals of this group.

71-79

Authors: КУЗМІНОВ Б. П., САГАЙДАКОВСЬКИЙ М. М., СМОЛЬНИЦЬКА В. Л.

On the basis of the analysis of the scientific works and archival and documentary materials, the authors studied the history of the scientific legacy of G.S. Mosing, the outstanding epidemiologist of the twentieth century. The study of aetiology, pathogenesis, clinical picture and treatment of epidemic typhus is presented in the scientist’s works. Dr. G. Mosing developed the effective system of antiepidemic measures aimed at the complete elimination of this disease.