Health Risk Analysis

4-12

Authors: D.V. Efremenko, I.V. Kuznetsova, V.G. Orobey, А.А. Efremenkо, V.M. Dubyanskiy, E.A. Manin, D.A. Prislegina, O.V. Semenko

Mass events tend to become more and more dangerous for population health, as they cause various health risks, including infectious pathologies risks. Our research goal was to work out scientifically grounded approaches to assessing and managing epidemiologic risks as well as analyze their application practices implemented during preparation to the Olympics-2014, the Games themselves, as well as other mass events which took place in 2014–2016. We assessed epidemiologic complications risks with the use of diagnostic test-systems and applying a new technique which allowed for mass events peculiarities. The technique is based on infections ranking as per 3 potential danger categories in accordance with created criteria which represented quan-titative and qualitative predictive parameters (predictors). Application of risk-oriented approach and multi-factor analysis allowed us to detect exact possible maximum requirements for providing sanitary-epidemiologic welfare in terms of each separate nosologic form. As we enhanced our laboratory base with test-systems to provide specific indication as per accomplished calcu-lations, it enabled us, on one hand, to secure the required preparations, and, on the other hand, to avoid unnecessary expendi-tures. To facilitate decision-making process during the Olympics-2014 we used an innovative product, namely, a computer pro-gram based on geoinformation system (GIS). It helped us to simplify and to accelerate information exchange within the frame-works of intra- and interdepartmental interaction. "Dynamic epidemiologic threshold" was daily calculated for measles, chickenpox, acute enteric infections and acute respiratory viral infections of various etiology. And if it was exceeded or possibility of "epidemiologic spot" for one or several nosologies occurred, an automatic warning appeared in GIS. Planning prevention activities regarding feral herd infections and zoogenous extremely dangerous infections which were endemic for Sochi was accomplished taking the completed assessment into account. The positive experience obtained through risk-oriented organization of certain activities aimed at providing anti-epidemic safety of mass international events on the Russian Federation territory allows us to be optimistic about prospects of wider im-plementation of the approach described above and other similar approaches based on health risk analysis principles.

21-28

Authors: А.V. Matveichev, М.V. Talaeva, V.Yu. Talaev, N.V. Neumoina, K.M. Perfilova, D.G. Lapaev, E.V. Mokhonova, M.I. Tsyganova, V.N. Koptelova, Z.I. Nikitina, V.A. Lapin, D.A. Melent'ev

Estimating risks of infections induced by gram-negative Helicobacter pylori, is a vital problem for healthcare due to wide spread of the agent and wide range of induced pathologies which include malignant neoplasms in gastrointestinal tract. The agent is prone to long-term chronic persistence despite its "fragility" and its being greatly demanding to culturing conditions. The persistence issue is of special interest here as it is related to data on Helicobacter pylori capability to change immune response in infected people inducing suppressive regulatory immune reactions which are more favorable for the agent, both in stomach and in a whole body. Our research goal was to estimate Helicobacter pylori capability to induce differentiation of regulatory CD4+CD25+FoxP3+ human T-cells as basic mediators of immune response regulation under direct contact between bacteria and T-cells without any participation of most professional antigen-presenting cells. Our research objects were clinical isolates of Helicobacter pylori and T-lymphocytes samples taken from people who didn't have Helicobacter pylori-infection in their case history; isolates and samples were jointly cultivated in vitro. We applied cytofluorometry to estimate changes in regulatory T-cells content. We detected that if T-lymphocytes and Helicobacter pylori were jointly cultivated during 18 hours in ratios from 1:10 to 1:50, regulatory T-cells content in cultures increased 2.12 times on average. This effects doesn't require any dendritic cells in a culture and obviously affects T-lymphocytes which are originally committed to regulatory T-cells in their development. Also, in our opinion, influence exerted on regulatory T-cells differentiation is a specific feature of Helicobacter pylori.

38-46

Authors: M.R. Kamaltdinov, N.V. Zaitseva, P.Z. Shur

The article focuses on describing mathematical model of a multi-phase flow in antroduodenum and its application for predicting digestive process features, including pH level detection. The suggested sub-model representing antroduodenal area of gastrointestinal tract is being developed within the frameworks of mathematical multilevel model depicting evolution of damage to critical organs and systems under exposure to risk factors. We introduced damages as per three functions (motor, secretory and absorbing one) to several gastrointestinal tract zones (body of stomach, antrum, and duodenum) and to pancreas and liver, into the sub-model. Mathematical problem statement includes records of mass and impulse conservation equations for mixture of liquid incompressible phases; ratios for mass flow intensity vector due to diffusion processes; ratios for mass sources due to reactions, secretion and components absorption, food dissolution, initial and terminal conditions. We obtained numeric experiment results when drinks with various pH level (2.3; 3.5; 7) were consumed; they revealed that anomalous considerable increase in acidity occurred in pyloric opening zone and duodenal cap zone when a drink with pH level equal to 2.3 was consumed. The results presented in this work make a considerable contribution into mathematical modeling development used to describe multiphase flows in biological channels with variable form. We showed that obtained acidity levels in various antro-duodenum zones correspond to experimental data given in the works of other researchers. In future the model can be applied to predict risks of duodenum damages evolvement together with detecting areas of their localization under exposure to negative factors.

56-65

Authors: L.A. Pykhtina, O.M. Filkina, N.D. Gadzhimuradova, A.I. Malyshkina, S.B. Nazarov

Issues of health state and factors determining it in infants born due to in vitro fertilization (IVF) have been frequently dis-cussed over recent years. The question yet to be answered is whether health disorders are related to burdened pre-morbid state of a mother as per extragenital and obstetric-gynecologic pathology or they are caused by IVF. Selective transfer of only one embryo has tended to increase recently, and, given this trend, specialists all around the world, and in our country as well, face a problem of detecting risk factors which cause health disorders in children born in monocyesis after IVF. Prognostic algorithm for most frequent pathologies is being worked out and it will help to implement targeted and differentiated approach to their prevention. We have completed clinical examination of infants during the first year of their life; all these infants were born in monocyesis after IVF (n=121). We have also questioned and interviewed their parents and analyzed data taken from infants' development records over a year as well. We have applied Wald sequential mathematical analysis to determine risk factors and create prognostic tables comprising most frequent somatic health disorders such as congenital abnormalities, iron-deficiency anemia, atopic dermatitis, absence of perinatal CNS damage compensation. We have detected that factors related to a mother's and newborn's health (extragenital morbidity, obstetric-gynecologic case history, pregnancy course) exert their influence on health disorders evolvement in such children during their first year of life; we have also shown that social factors and factors associated with IVF procedure don't have any statistical significance.

84-90

Authors: T.N. Govyazina, Yu.A. Utochkin

We chose students from all the six years attending Medical and Prevention Faculty of Perm State Medical University named after academician E.A. Vagner as our research object. Our research goal was to examine and to assess basic behavioral risks which could cause health risks for students attending medical higher educational establishment. We applied a set of techniques in our work: information-bibliographic one (15 literature sources were studied, both periodicals and monographs), sociological one (467 students of Medical and Prevention Faculty were included into a one-time questioning, them all being an entire assembly), statistic one (we calculated relative values and mean values, as well as correlation coefficients). The research was performed in two steps; the first one was based on analyzing subjective evidence, namely, sociologic questioning results; in our second step we focused on examining pathologic damages as per medical examinations data as well as data on morbidity obtained from register of visits to a students' polyclinic. Students' health is a significant parameter of a society intellectual potential; specific weight of students, both males and females, who take care of their health amounts to 60.0 % and 96.5 % correspondingly. 100 % questioned girls and 58.3 % boys consider their health to be "good". There are gender-based discrepancies in estimating one's health state in all sub-groups and as per all reasons for its preservation. 45 % boys and 40 % girls with quite different self-estimation of their health combine work and study. Students tend to have bad habits as they constantly drink alcohol and smoke. Despite availability of considerable volumes of information on diseases prevention students don't try to use this information and preserve their health. Medical students' lifestyle has such peculiarities as non-rational nutrition, insufficient physical, social and medical activity.

98-105

Authors: V.I. Adrianovskiy, G.Ya. Lipatov, E.A. Kuz’mina, N.V. Zlygosteva, K.Yu. Russkikh, N.P. Sharipova, T.V. Bushueva, V.O. Ruzakov

In order to develop ideological grounds for complex assessment of industrial carcinogenic danger, we performed hygienic assessment of contribution made by working environment factors into carcinogenic risks formation for workers employed at blister copper production. The assessment included predictive values of occupational risks. We determined tumor markers levels for occupations with unacceptable levels of carcinogenic risks. We examined mortality caused by malignant neoplasms. It is shown that non-organic arsenic compounds applied in blister copper production are the main factor causing carcinogenic risks. As we calculated individual carcinogenic risks for 25-year working period we found out that total carcinogenic risks for all basic and supplementary occupations in copper-smelting workshops were within the 4th range (more than 1.0 х 10-3). Unacceptable predictive values of carcinogenic risks for 100 % examined occupations appeared already after 5 years of work. We detected excess levels of tumor markers in 73 % of examined workers with occupations characterized with unacceptable values of carcinogenic risks; 19 % of such workers had excess levels of two tumor markers at once. 9 % of examined workers had excess levels of Cyfra 21.1 tumor marker, 14,5 % of workers had high levels of СЕА tumor marker, and 59 % of workers had high levels of NSE tumor marker. Intensive mortality indices for male workers employed at copper-smelting workshops as per all localizations amounted to 153.14, whereas they amounted to only 127.25 per 100,000 people for other population groups. Workers employed at blister copper production had higher intensive mortality indices than other people in terms of such nosologies as malignant neoplasms in respiratory organs and chest (86.78 and 47.72 correspondingly), including lung cancer (71.47 and 43.48 correspondingly. The obtained results will help to work out a system for managing carcinogenic risks which will include regulating and controlling activities, managerial activities, technical and technological measures, financial and economic activities, medical and prevention activities plus rehabilitation activities, as well as information and educational activities.

116-124

Authors: A.D. Volgareva, L.K. Karimova, L.N. Mavrina, Z.F. Gimaeva, N.A. Beigul

The article summarizes the data obtained in long-term research on working conditions estimates and studying damages to hearing organs in workers employed at petrochemical plants. We chose workers employed at five basic organic synthesis productions as an object of our study; these productions include ethylene-propylene, ethylbenzene-styrene, organic alcohols production (butanol and 2-ethylhexanol), phthalic anhydride. We detected that heating furnaces, compressors, and pumps were the main noise sources at the examined productions. Our research revealed that noise levels at the examined productions varied from 60 to 99 decibel, and calculated equivalent noise levels reached the 3 hazard class with 1st and 2nd hazard degree. Audiometric research showed that signs of impacts exerted by noise on hearing organs of workers belonging to basic occupational groups (processing machine operators and pumps and compressor operators) occurred authentically more frequently than in case of control equipment mechanics and automatic equipment operators (comparison group) (<0,001). The highest risk of occupational hearing loss was detected for drivers while the same pathology evolved 1.5–2.0 times less frequently in processing machines operators. Frequency of hearing organs damage in all basic occupational groups authentically increased as working period grew. Signs of such damage increased dramatically in processing machines operators' group after 10 years of work but still the overall level was slightly lower than in drivers' group. It is shown that the most efficient measures of collective protection aimed at noise reduction are application of low-noise technological equipment, acoustic protection (sound insulation and sound absorption, etc), remote control, as well as rational labor and leisure regime. Medical care and vocational rehabilitation of people with occupational hearing loss also contribute significantly into sensory deafness prevention.

132-148

Authors: V.A. Kaptsov, V.N.Dainego

Risks of eye damage and eyesight deterioration to a great extent depend on how efficient a biomechanical eye system is under energy-saving lighting conditions. The system's efficiency is determined by its adequacy in managing pupils and ciliary muscle. We analyzed mathematical models describing changes in pupil's diameter which were determined by light-technical pa-rameters of illumination environment (luminance level and brightness). We highlighted the importance of ganglionic cells and the role they play in managing pupil's diameter (miosis) when they are exposed to blue light within 480 nm spectrum. Basing on the assessment of a pupil's constriction under exposure to various light stimuli (blue, red, and green ones) we worked out a melanopsin effect concept of a pupil's retention at miosis and showed that it could be a diagnostic sign of some diseases (age-related direct retinopathy, pancreatic diabetes) under exposure to a blue light impulse with a certain wave length. Under exposure to blue light within 480 nm spectrum ganglionic cells form a managing signal for a sphincter muscle of a pupil and ciliary muscle which provides accommodation (as per Helmholtz) and regulates aqueous humor flow in ciliary channel. All modern energy-saving light sources have a low energy level at wave length equal to 480 nm due to gap in their spectrum in comparison with sunlight spectrum with the same light temperature and luminance level. Inadequate management of pupil's diameter under artificial lighting conditions leads to melanopsin effect disorders and causes disharmony in managing aqueous humor outflow. All the above-stated factors under long-term visual load cause eye diseases risks in modern illumination environment. We detected that contemporary mathematic models describing pupil's diameter fluctuations needed to be refined allowing for new knowledge on functional peculiarities of retina cells and energy-saving light sources spectrum.