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BARENTS

BARENTSNewsletter on OccupationalHealth and SafetyVol. 2, No. 2/1999PublisherFinnish Institute ofOccupational HealthTopeliuksenkatu 41 a AFIN-00250 Helsinki, FinlandEditor in ChiefSuvi LehtinenEditorHanna VisalaLayoutTuula Solasaari-PekkiThe English and Russian translationshave been provided by KSC.Photograph on the cover page:André Maslennikov / Lehtikuva Oy© Finnish Institute ofOccupational Health, 1999ISSN 1455-8459The responsibility for opinions, expressedin signed articles, studies and othercontributions rests solely with theirauthors, and publication does not constitutean endorsement by the Finnish Instituteof Occupational Health of the opinionsexpressed in them.ContentsEditorial 35Dr. BrundtlandAn International Team Approach to Reproductiveand Developmental Health Issues among RussianFemale Nickel Workers 38Y. Thomassen & al., NorwayLegal provisions concerning the protection ofpregnant women at work 41H.Taskinen, FinlandTransborder Sharing Experience in OccupationalHealth and Safety for Inhabitants of the North 44E. Nikitina, RussiaStrategies to prevent tobacco smoking amongadults in Karelia 45N. Dorshakova, O. Barsukova, K. Nagovitsina, A. Sukalsky,RussiaAspects of women’s occupational health and safetyprotection 47N.Y. Yevdokimova, Y.A. Pogorely, RussiaWomen in the world of work 49S. Lehtinen, FinlandProphylaxis of visual fatigue of female workersunder high visual strainN. Malkova, Russia 51ÑîäåðæàíèåÒðàíñãðàíè÷íîå ðàñïðîñòðàíåíèå îïûòà âîõðàíå òðóäà ñåâåðÿí 52Ý.Íèêèòèíà, ÐîññèÿÃèãèåíè÷åñêèå àñïåêòû îõðàíû òðóäà æåíùèí âäåÿòåëüíîñòè öåíòðîâ ãîññàíýïèäíàäçîðàÌóðìàíñêîé îáëàñòè 53Í. Åâäîêèìîâà, Þ. Ïîãîðåëûé, ÐîññèÿÑòðàòåãèÿ ïðåäóïðåæäåíèÿ òàáàêîêóðåíèÿ ñðåäèâçðîñëîãî íàñåëåíèÿ Êàðåëèè 55Í.Â. Äîðøàêîâà, Î.Þ. Áàðñóêîâà, Ê.Â. Íàãîâèöèíà,À.À. Ñóêàëüñêèé, ÐîññèÿÏðîôèëàêòèêà çðèòåëüíîãî óòîìëåíèÿ ó æåíùèí,âûïîëíÿþùèõ òðóäîâûå îïåðàöèè ñ âûñîêèìíàïðÿæåíèåì çðåíèÿ 58Í.Þ. Ìàëüêîâà, Ðîññèÿ


Women’s workWomen’s position has muchimproved in recent yearsin many parts of the world.Yet effective action must be taken bydecision-makers and political leaderseverywhere to ensure adequateemployment opportunities for women,along with equal pay and full socialparticipation. To achieve this,greater gender sensitivity is neededin employment and all related socioeconomicand development policies.For huge numbers of poorwomen, everything they do is “work”.We need to recognise this by adoptinga broader official definition ofwork – one which includes bothwaged and unwaged activities. Thiswill help to acknowledge women’smajor non-monetary contributions tonational economies. It will also broaden the range of activitiesin which we might expect to find work-related health risks.UN estimates in 1995 showed that women’s unpaid domesticlabour accounted for 40% of GNP worldwide. It alsofound that in developing countries, up to 66% of women’swork is excluded from national accounting mechanisms.Today, traditional patterns of life are changing, and thedemand for paid work is escalating everywhere. Labour forceprofiles are changing along with social roles. Women are nowentering the labour force in increasing numbers, although oftenwith less education and fewer skills than men. Conversely,male employment figures have shrunk or remained static.This may seem advantageous to women. However, manyof the jobs they can do are concentrated in the informal sector.This provides flexibility and helps women to juggle their multipleroles. But benefits in the form of paid leave, maternityleave, social security, or health insurance are usually lacking.Female-headed households, or families where male membersare unemployed, can be further disadvantaged for this reason.Today, women increasingly take on tasks traditionallyperformed by men, either from choice or necessity, althoughoften with lower recompense or recognition. Reasons may bepositive or negative. The positive may include improved educationand skills. The negative may be linked with shortagesof men in society due to out-migration or civil conflict, whichincreases women’s responsibilities and workload.Other social and development issues may compound theproblems of working women. Illiteracy, for example, increasesrisks for cleaners and domestic workers exposed to toxicagents and solvents, as they cannot read warnings and adapttheir use of the products accordingly. And it is increasinglyclear that a frequent cause of illhealth, discomfort and inconvenienceto women workers is the unsuitableergonomic design of the tools, equipment,and workstations they use.These continue, in the main, to bedesigned around male norms and arenot adapted to women’s physiology.It is becoming clearer that wemust closely scrutinise the health risksof jobs which women perform in largenumbers. Pioneering research onwork intensity has shown that women’sjobs thought to be relatively undemanding,and therefore safe, mayin fact share features of work classifiedas “heavy” and usually done bymen. An example is the repetitive,high-speed piecework done by women,in factories or at home; over time,these jobs can lead to severe musculo-skeletal disorders anddisability, as well as high stress levels. This perception of workas demanding or undemanding can affect women’s healthseekingbehaviour, disease outcomes, patterns of compensationfor disability, and psychological wellbeing.A broader understanding of occupational risk factorsfor women is critical, as they enter the labour force in today’sincreasingly interdependent world. Globalisation has strongimplications for women’s work and health.This can be seen in the steep rise in female employmentin export industries based in developing countries. Relyingpredominantly on young, female, low-paid labour, these industriespresent both benefits and drawbacks. Women havethe benefit of formal sector work and a measure of independence,but salaries are low and health and safety regulationsoften deficient. Such jobs may also carry specific risks. In theflower industry and the microelectronics industry, for example,there are risks of exposure to toxic chemicals. In the burgeoninggarment industry worldwide, there are risks of respiratorydiseases and musculo-skeletal problems are widespread.These industries must be made safer for women if the benefitsare to outweigh the drawbacks.Fortunately, our view of work-related health risks is startingto change. The traditional focus on illness, accidents andinjury related to formal sector work (often men’s work) is givingground to a new approach. This calls for the developmentof comprehensive methods which take into account all activitiescarried out at home or at work. With these, we can moreeffectively study the multiple tasks which cumulatively contributeto women’s health problems. This is important if weare to gain a better understanding of health risks incurred inBarents Newsletter on Occup Health and Safety 1999;2:3535


the informal sector, where legislation or regulation is minimal.No health-and-safety measures in the workplace can beeffective, however, if we do not make rapid improvements insocial policies and services to support women’s participation inthe labour force. This in turn will require stronger representationand participation of women in decision-making relating tosuch policies.Gro Harlem Brundtland, MD, MPHDirector-GeneralWorld Health OrganizationÆåíñêèé òðóäÏîëîæåíèå æåíùèí â ïîñëåäíèå ãîäû çàìåòíîóëó÷øèëîñü âî âñåì ìèðå. Íåñìîòðÿ íà ýòî, ïîëèòè÷åñêèìèäåÿòåëÿìè ïîâñþäó äîëæíû áûòüïðèíÿòû ýôôåêòèâíûå ìåðû ê òîìó, ÷òîáû îáåñïå÷èòüæåíùèíàì ðàâíûå âîçìîæíîñòè òðóäîóñòðîéñòâà èîïëàòû òðóäà, à òàêæå ãàðàíòèðîâàííûå ñîöèàëüíûåâîçìîæíîñòè ïîëíîöåííîãî ó÷àñòèÿ â íåì. Äëÿ îñóùåñòâëåíèÿýòîãî íåîáõîäèìî ïðèâëåêàòü áîëüøå âíèìàíèÿê ðàâíûì âîçìîæíîñòÿì òðóäîóñòðîéñòâà îáîèõ ïîëîâ èñâÿçàííûì ñ ýòèì ñîöèàëüíî-ýêîíîìè÷åñêèì ïðîãðàììàì.Äëÿ ìíîãèõ ìàëîèìóùèõ æåíùèí “ðàáîòîé” ÿâëÿåòñÿâñå, ÷òî îíè äåëàþò. Íåîáõîäèìî îôèöèàëüíîåïðèçíàíèå ýòîãî è ïðèíÿòèå ê óïîòðåáëåíèþ áîëåå øèðîêîãîïîíÿòèÿ ðàáîòû - òàêîãî, êîòîðîå âêëþ÷àåò íå òîëüêîîïëà÷èâàåìóþ ðàáîòó, íî è íåîïëà÷èâàåìûé òðóä äîìà èâíå äîìà. Ýòî ïîìîæåò óâèäåòü íàñêîëüêî âåëèêî ó÷àñòèåíåèçìåðÿåìîé â äåíüãàõ ðàáîòû æåíùèí â ýêîíîìèêåñòðàíû. Ýòî, òàêæå, ðàñøèðèò ïîíÿòèå î âèäàõ ðàáîò,êîòîðûå ìîãóò îêàçûâàòü îòðèöàòåëüíîå âëèÿíèå íàçäîðîâüå è âûçûâàòü îïàñíîñòü íåñ÷àñòíûõ ñëó÷àåâ. 1995 ãîäó ïî äàííûì ÎÎÍ äîìàøíÿÿ ðàáîòàæåíùèí ñîñòàâëÿëà îêîëî 40% âñåãî ìèðîâîãî îáùåñòâåííîãîïðîäóêòà áðóòòî. Îäíîâðåìåííî áûëî îòìå÷åíî, ÷òîâ ðàçâèâàþùèõñÿ ñòðàíàõ äî 66% æåíñêîãî òðóäà îñòàåòñÿçà ïðåäåëàìè îôèöèàëüíîé îò÷åòíîñòè.Ñåãîäíÿ òðàäèöèîííûå ñòåðåîòèïû èçìåíÿþòñÿ èñïðîñ íà îïëà÷èâàåìóþ ðàáîòó ðàñòåò ïîâñþäó. Èçìåíÿþòñÿïðîôèëè ðàáî÷åé ñèëû, òàêæå êàê è ñîöèàëüíûåðîëè. Âñå áîëüøå æåíùèí âñòóïàåò íà ðûíîê ðàáî÷åéñèëû, ïðàâäà, ÷àñòî ñ áîëåå íèçêèì îáðàçîâàòåëüíûì èïðîôåññèîíàëüíûì óðîâíåì, ÷åì ìóæ÷èíû. Çàíÿòîñòüìóæ÷èí, íàïðîòèâ, ëèáî ïîíèçèëàñü, ëèáî îñòàëàñüíåèçìåííîé.Ñèòóàöèÿ ìîæåò ïîêàçàòüñÿ áëàãîïðèÿòíîé äëÿæåíùèí. Îäíàêî, áîëüøèíñòâî ðàáîò, âûïîëíÿåìûõæåíùèíàìè, ñêîíöåíòðèðîâàíî â òàê íàçûâàåìîìíåôîðìàëüíîì ñåêòîðå. Ýòî äàåò âîçìîæíîñòè ãèáêîãîðàáî÷åãî ãðàôèêà è ïîìîãàåò æåíùèíàì èçáåæàòü íàïðÿæåíèÿ,ñâÿçàííîãî ñ ñîâìåùåíèåì íåñêîëüêèõ ñîöèàëüíûõðîëåé. Ïðè ýòîì îíè ëèøåíû ìíîãèõ âûãîä, äàâàåìûõïîñòîÿííûì òðóäîâûì îòíîøåíèåì, òàêèõ êàê åæåãîäíûéîòïóñê, îòïóñê ïî óõîäó çà ðåáåíêîì, ãàðàíòèðîâàííîåïîñîáèå â ñëó÷àå óâîëüíåíèÿ è ñòðàõîâàíèå íà ñëó÷àéáîëåçíè. Ïî ýòîé ïðè÷èíå õîçÿéñòâà, íàõîäÿùèåñÿ íàñîäåðæàíèè æåíùèí, èëè ñåìüè, â êîòîðûõ ìóæ÷èíàÿâëÿåòñÿ áåçðàáîòíûì, ìîãóò îêàçàòüñÿ â îñîáåííîíåâûãîäíîì ïîëîæåíèè. íàñòîÿùåå âðåìÿ æåíùèíû, ïî ñîáñòâåííîìóæåëàíèþ èëè ïî íåîáõîäèìîñòè, âñå ÷àùå áåðóòñÿ çàðàáîòó, êîòîðàÿ òðàäèöèîííî ñ÷èòàëàñü ìóæñêîé, õîòÿ÷àñòî ñ áîëåå íèçêîé îïëàòîé è ñ ìåíüøèì ïðèçíàíèåì.Ïðè÷èíû ïðèõîäà æåíùèí â “ìóæñêèå îáëàñòè çàíÿòîñòè”ìîãóò áûòü êàê ïîëîæèòåëüíûìè, òàê è îòðèöàòåëüíûìè.Ïîëîæèòåëüíûìè ïðè÷èíàìè ìîãóò áûòüíàçâàíû ïîâûñèâøèéñÿ óðîâåíü îáðàçîâàíèÿ è ïðîôåññèîíàëüíîãîìàñòåðñòâà æåíùèí. Îòðèöàòåëüíûå ìîãóò áûòüñâÿçàíû ñ íåäîñòàòêîì ìóæ÷èí â îáùåñòâå â ñâÿçè ñýìèãðàöèåé èëè âîåííûìè êîíôëèêòàìè, ÷òî óâåëè÷èâàåòîòâåòñòâåííîñòü è íàãðóçêó æåíùèí.Ïðîáëåìû ðàáîòàþùèõ æåíùèí ìîãóò áûòü âûçâàíûè äðóãèìè ñîöèàëüíûìè ïðè÷èíàìè. Íàïðèìåð, íåãðàìîòíîñòüóâåëè÷èâàåò ðèñê äëÿ óáîðùèö è äîìðàáîòíèö36Barents Newsletter on Occup Health and Safety 1999;2:36-3736


ïîäâåðãíóòüñÿ âîçäåéñòâèþ ÿäîâèòûõ âåùåñòâ è ðàñòâîðîâ,òàê êàê îíè íå ìîãóò ïðî÷åñòü èíñòðóêöèé è ó÷åñòüèõ â ñâåé ðàáîòå. Ê òîìó æå, âñå ÷àùå ïðè÷èíîé òðàâì,çàáîëåâàíèé è íåóäîáñòâ äëÿ ðàáîòàþùèõ æåíùèíÿâëÿåòñÿ ïëîõîå èëè íåäîñòàòî÷íîå ïðèñïîñîáëåíèåèíñòðóìåíòîâ è ðàáî÷èõ ìåñò. Ïî áîëüøåé ÷àñòèîáîðóäîâàíèå è ðàáî÷èå ìåñòà ðàññ÷èòàíû íà èñïîëüçîâàíèåèõ ìóæ÷èíàìè è èõ íå ïðîñïîñàáëèâàþò äëÿæåíùèí.Ñîâåðøåííî ÿñíî, ÷òî íåîáõîäèìî ïðèâëå÷ü áîëååïðèñòàëüíîå âíèìàíèå ê ðèñêàì äëÿ çäîðîâüÿ, âûçûâàåìûìâûïîëíÿåìûìè æåíùèíàìè ðàáîòàìè. Èññëåäîâàíèÿïîêàçàëè, ÷òî äàæå òàêèå æåíñêèå ðàáîòû, êîòîðûåñ÷èòàþòñÿ íåñëîæíûìè è ïîýòîìó áåçîïàñíûìè, ìîãóò ïîñóòè äåëà èìåòü îñîáåííîñòè ìíîãèõ ìóæñêèõ ðàáîò,ñ÷èòàåìûõ òÿæåëûìè. Íàïðèìåð, âûïîëíÿåìûå æåíùèíàìèêàê íà çàâîäàõ, òàê êàê è äîìà, îäíîîáðàçíûå,ñîäåðæàùèå ïîâòîðÿþùèåñÿ äâèæåíèÿ ðàáîòû. Ñîâðåìåíåì òàêèå ðàáîòû ìîãóò âûçûâàòü òÿæåëûå êîñòíîìûøå÷íûåçàáîëåâàíèÿ è íåòðóäîñïîñîáíîñòü, à òàêæåñòðåññ. Îøèáî÷íàÿ îöåíêà ðàáîòû êàê ñëîæíîé èëèíåñëîæíîé, ìîæåò âëèÿòü íà îòíîøåíèå æåíùèí ê ñâîåìóçäîðîâüþ, âîçíèêíîâåíèå áîëåçíåé, ïðàêòèêó ïîñîáèé ïîáîëåçíè è îáùóþ ïñèõîëîãè÷åñêóþ óäîâëåòâîðåííîñòü.Áîëåå øèðîêîå ïîíèìàíèå ïðîôåññèîíàëüíûõçàáîëåâàíèé æåíùèí æèçíåííî âàæíî â ñâÿçè ñ ðîñòîìäîëè æåíñêîãî òðóäà â ìèðîâîì õîçÿéñòâå, ãäå ðàçëè÷íûåñòðàíû ñ ðàçëè÷íûìè îáùåñòâåííûìè ñèñòåìàìè ïîëíîñòüþçàâèñèìû äðóã îò äðóãà. Ãëîáàëüíîñòü èìååòñèëüíåéøåå âëèÿíèå íà ðàáîòó è çäîðîâüå æåíùèí.Ýòî çàìåòíî â ðåçêî âîçðàñòàþùåé äîëå æåíñêîãîòðóäà â ýêñïîðòíîé ïðîìûøëåííîñòè ðàçâèâþùèõñÿñòðàí. Ïðîìûøëåííîñòü ýòèõ ñòðàí îïèðàåòñÿ â îñíîâíîìíà òðóä ìîëîäûõ, ïîëó÷àþùèõ íèçêóþ çàðàáîòíóþ ïëàòóæåíùèí, ÷òî èìååò ñâîè ïðåèìóùåñòâà è íåäîñòàòêè.Ñ îäíîé ñòîðîíû - æåíùèíû ðàáîòàþò â îôèöèàëüíîìñåêòîðå, îíè íåçàâèñèìû, ñ äðóãîé — ïîëó÷àåìàÿèìè çàðïëàòà íèçêà è êàñàþùèåñÿ çäîðîâüÿ è áåçîïàñíîñòèòðóäà çàêîíû ÷àñòî íåäîñòàòî÷íû. Ðàáîòà ìîæåò áûòüòàêæå ñâÿçàíà ñî ñïåöèôè÷åñêèìè ðèñêàìè. Íàïðèìåð,ïðè âûðàùèâàíèè öâåòîâ è â ðàáîòå ñ ìèêðîýëåêòðîíèêîéìîæíî ïîäâåðãíóòüñÿ äåéñòâèþ âðåäíûõ õèìèêàëèé. Âáûñòðî ðàñòóùåé øâåéíîé ïðîìûøëåííîñòè ñóùåñòâóåòðèñê ïîëó÷èòü çàáîëåâàíèÿ äûõàòåëüíûõ ïóòåé, à òàêæåøèðîêî ðàñïðîñòðàíåíû êîñòíî-ìûøå÷íûå çàáîëåâàíèÿ.Íåîáõîäèìî ïðèâëå÷ü îñîáîå âíèìàíèå ê áåçîïàñíîñòèòðóäà â ýòèõ îáëàñòÿõ ïðîìûøëåííîñòè, åñëè ìû õîòèì,÷òîáû ïîëîæèòåëüíûå äëÿ æåíùèí ìîìåíòû ïåðåâåñèëèîòðèöàòåëüíûå.Ê ñ÷àñòüþ, íàøå îòíîøåíèå ê ñâÿçàííîìó ñ ðàáîòîéðèñêó äëÿ çäîðîâüÿ íà÷èíàåò ìåíÿòüñÿ.Ïî òðàäèöèè îñíîâíîå âíèìàíèå óäåëÿåòñÿ ðàáîòàìîôèöèàëüíîãî ñåêòîðà (÷àñòî ýòî ðàáîòû, âûïîëíÿåìûåìóæ÷èíàìè), è âûçûâàåìûì èìè áîëåçíÿì, íåñ÷àñòíûìñëó÷àÿì è òðàâìàì. Ýòî, îäíàêî, ñîçäàåò îñíîâàíèå äëÿíîâîãî ïîäõîäà. Íåîáõîäèìî ðàçâèòèå ìåòîäîâ áîëååøèðîêîãî îõâàòà è ðàññìîòðåíèÿ, ïðèíèìàþùåãî âîâíèìàíèå âñþ ðàáîòó, êàê îïëà÷èâàåìóþ, ïðîèçâîäèìóþíà ðàáî÷åì ìåñòå, òàê è ñîâåðøàåìóþ äîìà äîìàøíþþðàáîòó. Ñ èñïîëüçîâàíèåì ýòèõ ìåòîäîâ ìû ñìîæåìýôôåêòèâíåå èññëåäîâàòü òå ìíîãî÷èñëåííûå òðóäîâûåäåéñòâèÿ, êîòîðûå â êîìïëåêñå îêàçûâàþò âëèÿíèå íàçäîðîâüå æåíùèí. Ýòî âàæíî äëÿ ïîíèìàíèÿ ðèñêîâ äëÿçäîðîâüÿ, ñîçäàþùèõñÿ â òàê íàçûâàåìîì íåôîðìàëüíîìñåêòîðå, ãäå âîçäåéñòâèå çàêîíàäàòåëüñòâà èëè êàêîãîëèáîäðóãîãî ðåãóëèðîâàíèÿ ìèíèìàëüíî.Íèêàêèå ïðèíèìàåìûå íà ðàáî÷åì ìåñòå ìåðû ïîîõðàíå çäîðîâüÿ è áåçîïàñíîñòè òðóäà íå ìîãóò áûòüýôôåêòèâíû, åñëè íå áóäóò ðàçðàáîòàíû ñîöèàëüíîïîëèòè÷åñêèåïðîãðàììû è ó÷ðåæäåíû ñëóæáû, êîòîðûåïîääåðæèâàþò ó÷àñòèå æåíùèí â òðóäîâîé æèçíè. Ýòî âñâîþ î÷åðåäü òðåáóåò áîëåå àêòèâíîãî ó÷àñòèÿ æåíùèíâ ïðèíÿòèè ðåøåíèé, êàñàþùèõñÿ ñîçäàíèÿ òàêèõ ïðîãðàìì.Ãðó Õàðëåì Áðóíäòëàíä, ÌÄ, ÌÏÕÃåíåðàëüíûé äèðåêòîðÂñåìèðíîé Îðãàíèçàöèè ïî Îõðàíå ÇäîðîâüÿBarents Newsletter on Occup Health and Safety 1999;2:35-371999;2:36-3737


An International Team Approach toReproductive and DevelopmentalHealth Issues amongRussian Female Nickel WorkersVP Tchachtchine 1 , Y Thomassen 2 , I Kovalev 3 ,JØ Odland 4 , S Ignatikova 1 ,PE Fiskebeck 5 , E Lund 4 , T Norseth 2 , D Ellingsen 2 ,E Nieboer 4, 6IntroductionThis story began in 1989 when healthofficials of the Kola Peninsula andFinnmark County met to discuss the possibleenvironmental and health impact ofthe pollution associated with nickel refiningin the Kola Peninsula. Subsequently,collaboration was initiated adressingboth environmental health and occupationalhealth concerns. The joint publichealth projects have been completed andmost of the findings have been published(1, 2, 3). The joint efforts in occupationalhealth have focused on reproductiveand developmentalhealth among femalenickel refinery workersemployed at theSeveronickel Refineryin Monchegorsk.A brief summary ofthe accomplishmentsto date and current effortsare describedhere. For additionaldetails, the reader isreferred to Odland etal. (4).BackgroundThe mining and refining of nickel is animportant industry in arctic and subarcticregions, especially in Russia and Canada.The activities in Norway and Finlandare limited to nickel refining. Todate, the major health outcomes associatedwith occupational exposure in thenickel industry have been nasal and lungcancers (5, 6), as well as allergies manifestedas contact dermatitis (eczema) andasthma. In countries other than Russia,very few female nickel workers are employedin jobs with high levels of exposureto nickel and refinery intermediates.For example, in some departments of theMonchegorsk nickel refinery, womenconstitute 30–40% of the workforce. In1992 one of the authors (VPT) presenteda paper at the Fifth International Conferenceon Nickel Biochemistry, Toxicologyand Ecologic Issues held in Sudbury,Canada, and expressed concern about reproductiveand developmental health outcomesamong female workers employedin the Monchegorsk nickel refinery. Increasesin spontaneous abortions andstructural malformations in newborn babieswere identified (7). These observationswarranted closerscrutiny and follow-up,which resulted in the KolaFeasibility Study (8) describedbelow.The Kola BirthRegistryIt became obvious frominformal discussions thatestablishing a birth registryin the towns with thenickel refineries, namely1Kola Research Laboratory for Occupational Health, Kirovsk, Russia2National Institute of Occupational Health, Oslo, Norway3Murmansk Regional Health Administration4Institute of Community Medicine, University of Tromsø, Norway5Office of the Finnmark County Governor, Department of Environmental Affairs, Vadsø, Norway6Department of Biochemistry and Occupational Health Program, McMaster University, Hamilton, Ontario, Canada.38 Barents Newsletter on Occup Health and Safety 1999;2:38–40


Monchegorsk, Nikel andZapolyarniy, needed to bea primary objective. Inthe years 1996 and 1997,the Registry was constructedretrospectivelyfor the towns of Nikel,Zapolyarniy and Monchegorsk;it covered all births(a total of 4 752) for theperiod 1986–1993. Theregistry project was first begun in Nikeland Zapolyarniy. During 1998, thenumber of entries nearly doubled whenthe years 1981–1985 were included forMonchegorsk. On command, the Registryprovides individual or summary informationabout specific particulars ofthe mother or her newborn, includingmaternal employment details, pregnancynumber and outcomes, and the healthstatus of the neonate. More than 40 itemsof information are registered for eachmother/neonate pair. The sources of theinformation were the hospital deliverydepartment journals and the MunicipalRegistration Board, supplemented byhospital gynecological records. Hospitalsare required to archive structured formsdetailing each birth and neonatal historyfor 25 years from the date of birth. TheRegional Health Administration of MurmanskCounty and the federal Ministryof Internal Affairs have since 1973 exercisedstrict supervision to ensure the accurateand complete registry of all deliveries.In 1993, the federal authority wasconsolidated under the Federal Law ofArchives.The information in the Registrywas verified by consulting in a blind fashionthe records of the delivery department.In the Monchegorsk component ofthe Registry database, the percentage ofincorrect items was very low (


Worker questionnaireInformation about socio-economic conditions,life-style factors and other confoundersare not documented in sufficientdetail in the Kola Birth Registry for usein epidemiological research (e.g. familyhistory of inherited diseases, family income,use of contraceptives, breastfeedingpractices, eating habits, consumptionof alcohol and tobacco). This type of informationneeds to be assessed througha questionnaire, and this was done in ourFeasibility Study (8). An interview formatwith physicians as the interviewerswas found to be the most appropriate.Clarification of the work environmentbeyond that available from companyrecords was also obtained in this manner,such as the presence of recognizedhazards (e.g. vibration, other physicalagents) or the workload of the job.ConclusionsInformation on reproductive/developmentaloutcome and workplace historieswere found to be of acceptable quality. Awell designed, comprehensive epidemiologicalstudy is technically feasible becauseof the availability of a favourablepool of study subjects, reproductive/developmentaloutcome data, informationto control for major confounders, andsuitable occupational records. A cohortstudy of life-time pregnancy outcomes ofall former and current female nickelworkers employed between 1 January1970 and 1 January 2000 by the threenickel refineries in the Kola Peninsula isin planning stage. Calculations of samplesize indicate that such a study wouldbe amenable and suitable to detect anexcess risk of spontaneous abortions withadequate statistical significance. Such aninvestigation would need to be supplementedby workplace environmental andbiological monitoring assessments to assessexposure to occupational hazardsand a questionnaire on information aboutlife-style factors. A case-control studywithin the Kola Birth Registry is contemplatedfor studying congenital defects. Itis hoped that the approach describedmight be extended to other industries inRussia.Personal observationsIn a recent commentary, Little and colleagues(10) indicated that differences indisease classification was an obstacle toepidemiological research in countriesformerly part of the Soviet Union. In ourexperience, such differences were readilyresolved through discussions that focusedon the application of the ICD-9classification, which was available in theRussian language.PostscriptAs a practical result of our work, the FederalGovernment of Russia is consideringextending a simplified version of theKola Birth Registry to all counties of thefederation. The staff of KRLOH act asprincipal advisers to the Federal HealthDepartment, with the other authors constitutingan expert advisory group.References1. Smith-Sivertsen T, Tchachtchine VP,Lund E, Norseth T, Bykov V. The Norwegian-RussianHealth Study 1994/95.A Cross-sectional Study of Pollutionand Health in the Border Area. Tromsø:University of Tromsø 1997. (ISMSkriftserie Nr. 42, University of Tromsø.)2. Smith-Sivertsen T, Tchachtchine VP,Lund E, Bykov V, Thomassen Y, NorsethT. Urinary nickel excretion in populationsliving in the proximity of twoRussian nickel refineries: A Norwegian-Russianpopulation-based study.Environ Health Perspect 1998;106:503–11.3. Odland JO, Nieboer E, Romanova N,Thomassen Y, Norseth T, Lund E. Urinarynickel concentraions and selectedpregnancy outcomes in deliveringwomen and their newborns among arcticpopulations of Norway and Russia.J Environ Monit 1999;1: in press.4. Odland JO, Tchachtchine VP, BykovV, Fiskebeck PE, Lund E, ThomassenY, Nieboer E. Critical evaluation ofmedical, statistical and occupationaldata sources in the Kola Peninsula ofRussia pertinent to reproductive healthstudies. Int Arch Occup Environ Health1999; in press.5. International Agency for Research onCancer. Chromium, nickel and welding,volume 49. Geneva: World HealthOrganization, 1990. (IARC monographson the evaluation of carcinogenicrisks to humans.)6. Doll R Sir (ed-in-chief). Report of theInternational Committee on NickelCarcinogenesis in Man. Scand J WorkEnviron Health 1990;16:1–82.7. Chashschin VP, Artunina GP, NorsethT. Congenital defects, abortion and otherhealth effects in nickel refineryworkers. Sci Total Environ 1994;148:287–91.8. Nieboer E, Tchachtchine VP, OdlandJØ, Thomassen Y. Reproductive anddevelopmental health in relation tooccupational exposure to nickel in theKola Peninsula of Russia: a feasibilitystudy, July 1997. (McMaster UniversityResearch Document, Hamilton,Canada.)9. Thomassen Y, Nieboer E, Ellingsen D,Hetland S, Norseth T, Odland JØ, RomanovaN, Chernova S, TchactchineVP. Characterization of workers’ exposurein a Russian nickel refinery. JEnviron Monit 1999;1:15–22.10. Little RE, Gladen BC, AtaniyazovaOA, Monaghan SC, Tabacova S, ZadorozhnajaTD, Mendel NA. Bridgesbetween east and west. Epidemiology1997;8:107–9.40 Barents Newsletter on Occup Health and Safety 1999;2:38–40


Legal provisions concerningthe protection of pregnant womenat workHeikki Frilander, Helena Taskinen, FinlandLegislative measures to diminish the riskthat work impos es on a pregnant womanand on her unborn child have been introducedin a number of countries and inthe European Union over the last twodecades. In Finland, legislative protectioncovers the reproductive health ofworking men and women.Written guidelines and expert consultationare available to the workplace physician.A statute deriving from the law onoccupational safety advises the employeron how to minimize risks. Improvementsin working conditions and work organization,and the selection of the safestpossible materials are recommendedas primary methods of prevention. Accompanyingregulations list agents consideredcapable of causing genetic damage,of affecting the fertility of the maleor the female worker, and of being hazardousto the unborn child or to pregnancy(Table 1).BackgroundIn some countries – in Denmark and inCanada (Quebec) since 1981 and in Finlandsince 1991 – a pregnant woman hasbeen entitled to receive publicly paidmaintenance allowance if her work resultsin risks to her foetus or herself (1,2).The employer must try to reduce the estimatedrisk or try to find a less hazardouswork environment for the woman. Ifthis is not possible, the woman may takepaid leave without incurring a reductionin her normal maternity leave (Denmarkand Finland).FinlandIn Finland, the idea of preventing workplace-relatedreproductive hazards at theworkplace has been integrated into legislationthrough two different types oflaws (3). The legislation on occupationalsafety obliges the employer to makesure that work conditions are not likelyto cause genetic damage to the workerand are not harmful to the unborn babyor to the reproductive health and pregnancyof the worker.The legislation on special maternityleave allows a woman who is exposedto agents considered harmful topregnancy or to her offspring to requesta transfer to safe work from the beginningof the pregnancy onwards. If such atask cannot be offered, the woman maybe entitled to special maternity leave andbenefits. A special maternity allowanceis paid by the Social Insurance Institution.The risk assessment is done by anoccupational physician who knows theworkplace and the exposure situation.Table 1. List of agents considered hazardous to the genotype, foetus and reproductionType of agentAgentGenotoxicBenzeneEpichlorineEthylene oxideGenotoxic antineoplastic agentsStyrene oxideVinyl chlorideIonizing radiation, including radionuclidesReproductive toxicantsDibromochloropropane(affecting fertility, etc.)Lead and inorganic lead compounds2-EthoxyethanolEthylene dibromideChloropreneManganese2-methoxyethanolCarbon disulfideSynthetic estrogens and progestagensChemicals which according to occupational and safetylegislation, or legislation concerning chemicals, carry thewarning sign R61 or R63 (harmful to the foetus)Harmful during pregnancyChemicalCarcinogensAnaesthetic gasesMercury and its compoundsCarbon monoxideLeadCytostatic drugsOrganic solventsChemicals which according to occupational and safetylegislation, or legislation concerning chemicals, carry thewarning sign R45 (mutagenic), R46 (carcinogenic), R 47(teratogenic), R49 (carcinogenic when inhaled) or R 60-63(harmful to fertility or the foetus)BiologicalViruses: hepatitis B, herpes, cytomegalo, varicella, rubella,human immunodeficiency virusBacteria: listeriaToxoplasmaPhysicalIonizing radiation, including radionuclidesBarents Newsletter on Occup Health and Safety 1999;2:41–4341


The regulations and guidelines accompanyingthe legislation on specialmaternity leave include a list of agentspossibly harmful to pregnancy. Agentsconsidered here as possibly being harmfulare the same as those listed in Table1. For inclusion on the list of agents, strictcriteria have been applied. Chemicalswhose harmful effects on the foetus orpregnancy have been shown in at leasttwo well-conducted epidemiologicalstudies are included on the list, as arechemicals with warning signs R45, R46and R47 designated on the basis of occupational,safety and chemical legislation(3). Later, chemicals with the warningsigns R49 (carcinogenic when inhaled),R60 and 62 (toxic to fertility) andR61 and 63 (toxic to the foetus duringpregnancy) were also included under theregulations. Not only the presence of thechemicals in the workplace but also theexposure level has to be taken into accountassessing the need for job transferor special maternity leave. The guidelinesalso give suggestions concerning the levelof exposure considered harmful (Table2).Physically heavy work or work involvingergonomically poor positions isnot included in the special maternityleave regulations in Finland.If the woman is not satisfied withthe risk assessment, she can ask anotherphysician for a second opinion. If she isnot satisfied with the decision on her specialmaternity leave, she can appeal tothe Social Insurance board or, taking thecase further, to the Inspector board.European CommunityDirective 92/85/EEC identifies pregnantworkers and workers who have givenbirth recently or are breastfeeding asgroup of workers facing specific risks inthe workplace (4). The Directive providesthat the employer must make anassessment of the workplace and thework of pregnant or breastfeeding womenand women who have recently givenbirth. If the assessment reveals a risk tohealth and safety, all reasonable stepsmust be taken to ensure that the risk isavoided.The employer is required to takethe necessary steps to alter the work environmentin order to avoid the risk. Ifthis is not possible, the employee is tobe transferred to another job not involvingrisk. If transferring her is not feasible,the worker is to be granted leave inaccordance with the national legislationor national practice; for example, specialmaternity leave (4).Pregnant women cannot be dischargedfor pregnancy-related reasons orforced to work if this will damage theirhealth. Non-exhaustive lists of agents andworking conditions considered to be harmfulare provided (Table 3).The Member States were obligatedto enforce the Directive within twoyears after its adoption. Before the Directivewas adopted, all Member Stateshad some form of protection for pregnantworkers, although it varied considerably.In some countries, the protectionprovided was higher than that requiredby the Directive, whereas in others theTable 2. The level of exposure which is considered potentially harmful during pregnancy.AgentExposure level considered harmfulAnaesthetic gases Halothane 1 ppm/8h, 3 ppm/15min 1)Nitrous oxide 100 ppm/8h 1)Isoflurane, enflurane 10 ppm/8h 1)Inorganic lead B-Pb 0.3 µmol/L 2)Mercury U-Hg 50 nmol/L 2)Cytostatic drugsCarbon monoxideOrganic solventsCarcinogensIonizing radiation including radionuclides1) Finnish occupational hygienic reference valuePreparation of the drug solution fortherapeutic administration14 ppm/8h10% of the Finnish occupationalhygienic valueAny exposure at all2 mSv on the abdominal skin (= 1mSvin the foetus)Directive had the effect of increasing thehealth and safety protection and the employmentrights of pregnant workers (5).ExperienceIn both Denmark (c. 1% of pregnantwomen) and Finland (0.1%), fewer pregnantwomen than expected have been takingadvantage of special maternity leave(1). The difference between the twoNordic countries as far as the taking ofspecial maternity leave is concerned derivespartly from the fact that physicalstrain is accepted as a reason for the grantingof such leave in Denmark, but not inFinland. In Quebec, nearly four out of tenpregnant women benefit from preventivereassignment measures (2). In Finland thenumber of mothers taking advantage ofspecial maternity leave did not increaseduring the period 1992–97. In about onethird of the risk assessment processes inFinland, no risk has been found (6). InFinland, the main reason for the grantingof special maternity leave has been exposureto organic solvents. Further reasonshave been other industrial chemicals,radiation and anaesthetic gases (1).The report on the implementationof Directive 92/85/EEC concludes thatthe Directive has generally been well implementedby the Member States, mostof them having amended their legislationto take specific account of pregnant workersand the non-exhaustive list of agents,processes and working conditions givenin the Directive (5).The legislation not only benefitsexpectant mothers but also focuses attentionon workplace safety in general, thusbenefiting all workers. If the workplaceis safe for pregnant women, it is safe forother workers as well. The real solutionis to decrease the exposure of female andmale workers to reproductive toxicants,not only to protect already pregnant women.However, international experienceshows that employers tend to take the easyway out, not reducing risks at the workplacebut giving women new tasks oravoiding the problem through the expediencyof special maternity leave or sickleave. When occupational exposure limitsare established, reproductive toxicityshould be also taken into account. Thiswould help in avoiding discriminationagainst women because of their reproductivecapacity.2) The Finnish reference value for the exposure of the general population.42 Barents Newsletter on Occup Health and Safety 1999;2:41–43


References1. Taskinen H, Olsen J, Bach B. Experiencesin Developing Legislation ProtectingReproductive Health. Am COccup Environ Med 1995;37:974–9.2. Plante R, Malenfant R. ReproductiveHealth and Work: Different Experiences.J Occup Environ Med 1998;40:964–8.3. Taskinen H. Prevention of reproductivehealth hazards at work. Scand JWork Environ Health. 1992;18 (Suppl2):27–9.4. The Council Directive 92/85/EEC ofOctober 19,1992: the introduction ofmeasures to encourage improvementsin the safety and health at work of pregnantworkers and workers who have recentlygiven birth or are breastfeeding.Official J Eur Commun. 1992;Nov:L348/1–8.5. Report from the Commission on theimplementation of Council Directive92/85/EEC, Brussels, 1999.6.Taskinen H, Virtanen S. Abstracts;PREMUS-ISEOH ’98; 13th InternationalSymposium on Epidemiology inOccupational Health:1998; p. 271.Finnish LegislationAct on Occupational Safety 27/1987Decree of the Council of State 1043/1991Decree of the Ministry of Labour 1044/1991Act on Sickness Insurance 1192/1990Ordinance on Sickness Insurance 717/1991Decree of the Ministry of Social Affairsand Health 931/1991Table 3. Annexes I and II of Directive 92/85/EEC.Non-Exhaustive List of Agents, Processes and Working Conditions referred to in Article 4ASSESSMENT AND MEASURES REQUIREDA. Agents1. Physical agents where these are Shocks, vibration or movementregarded as agents causing foetal lesions Handling of loads entailing risks, particularlyand/or likely to disrupt placental attachment, of a dorsolumbar natureand in particular:NoiseIonizing radiationNon-ionizing radiationExtremes of cold or heatMovements and postures, travelling − eitherinside or outside the establishment − mentaland physical fatigue and other physicalburdens connected with the activity of theworker within the meaning of Article 2 of theDirective.2. Biological agentsBiological agents of risk groups 2, 3 and 3within the meaning of Article 2 (d) numbers 2,3 and 4 of Directive 90/679/EEC, in so far asit is known that these agents or thetherapeutic measures necessitated by suchagents endanger the health of pregnantwomen and the unborn child and in so far asthey do not yet appear in Annex II.3. Chemical agentsThe following chemical agents in so far as it is Substances labelled R 40, R 45, R 46, and Rknown that they endanger the health of 47 under Directive 67/548/EEC in so far aspregnant women and the unborn child and in they do not yet appear in Annex IIso far as they do not yet appear in Annex II: Chemical agents in Annex I to Directive90/394/EECMercury and mercury derivatives;Antimitotic drugs;Carbon monoxide;Chemical agents of known and dangerouspercutaneous absorption.B. Processes Industrial processes listed in Annex I toDirective 90/394/EEC.C. Working conditions Underground mining work.Heikki FrilanderFinnish Institute of OccupationalHealthTopeliuksenkatu 41 a A00250 HelsinkiFinlandE-mail: Heikki.Frilander@occuphealth.fiHelena TaskinenFinnish Institute of OccupationalHealthTopeliuksenkatu 41 a A00250 HelsinkiFinlandEXPOSURE OF PREGNANT OR BREASTFEEDING WORKERS IS PROHIBITEDNon-exhaustive list of agents and working conditions referred to in Article 6Pregnant workers1. AgentsPhysical agentsWork in hyperbaric atmosphere, e.g.pressurized enclosures and underwaterdivingBiological agentsThe following biological agents:toxoplasmarubella virusunless the pregnant workers are proved to beadequately protected against such agents byimmunizationChemical agentsLead and lead derivatives in so far as theseagents are capable of being absorbed by thehuman organism2. Working conditions Underground mining work.Barents Newsletter on Occup Health and Safety 1999;2:41–4343


Transborder SharingExperiencein Occupational Health and Safetyfor Inhabitants of the NorthEmma NikitinaTransboder sharing experiencein occupational health and safety for inhabitants of the NorthSince May, 1995, the Committee of Labour,Employment and Migration of Populationat the Administration of the MurmanskCounty (Oblcomtrud) co-operateswith similar state bodies in other provincesof the Barents region in order toimprove regional systems for labour protection,occupational health and safety.For the sharing of international experience,special workshops and seminarswere arranged in Murmansk by Oblcomtrudin collaboration with the labour protectionunits from Finnmark and Toms(Norway) and Lapland and Oulu (Finland).These resulted in some actualagreements on joint projects. A prominentexample is the First International Seminar«The Prevention of OccupationalDiseases and Accidents: Methods used inHealth, Environmental and Safety Work»which was held in Apatity at the InternationalCentre for Development of Science,Culture and Education in the BarentsRegion in September 1997.The contacts with Swedish partnerswere extended after the integration ofWesterbotten into the Barents Region. Asa first step, a Russian-Swedish Seminaron Labour Protection and OccupationalSafety, initiated by the Swedish OccupationalHealth Services (OHS) and theOblcomtrud, was arranged in Murmanskon 24-25 September 1998.The seminar was attended by 22participants, including 3 experts of OHS(Sweden), 14 officers of the MurmanskOblcomtrud, Union of Manufacturers andEntrepreneurs, Trade Union, State LabourInspection as well as researchers from theKola Research Laboratory for OccupationalHealth and the Centre of HumanAdaptive Power in the North (CHAP)at the Kola Science Centre RAS.The OHS experts Anders Jeppsson,Lena Elofsson and Per-AndersZingmark described the wide scope oftasks, the role and tools of OHS, theSwedish national OHS policy, and therelations between employers, trade unionsand governmental agencies. Themain features of the Swedish systemof accident and occupational morbidityinsurance were also highlighted.The second seminar day was devotedto the discussion of the furtherextention of co-operation between Swedenand the Murmansk region. From theRussian point of view, the most attractivemutual actions would be:• an exchange of information and experts,arrangement of joint seminars• comparison of tools for instrumentcontrol of labour conditions at theenterprises in Sweden and the Murmanskregion, aiming at harmonization• adopting the Swedish computerizsedmodel of the Accident and OccupationalDiseases Register in order toEmma NikitinaHead of Department ofOccupational SafetyCommittee of Labour, Employmentand Migration of Population at theAdministration of Murmansk County75, Lenin prospectMurmansk 183006, Russiatransfer appropriate software to the Murmanskregion• consulting and training for the staff ofthe Consulting and Methodical Centreof Labour Protection, established at theMurmansk Oblcomtrud, with the aim toassist enterprises in quality assuranceand certification of workplaces withinthe framework of the Tripartite Agreementand the Regional Programme onLabour Protection in 1997-99• learning the skills of inspecting labourprotection in small and middle-sizedenterprises in Sweden (less than 100employees)• comparison of the background of mandatoryinsurance systems for accidentsand occupational diseases in state andprivate enterprises in Sweden and theMurmansk region forh the purpose ofharmonization.The presentations of Dr. ElviraVlassova (CHAP KSC) «Studies of humanbeing individual responses to the northerngeliogeophysical risk factors» and Dr.Irina Perminova (INEP KSC) «Developmentof the rehabilitation methods of leadpoisoning by means based on local enterosorbents»aroused great interest.The seminar pointed out that OHSimprovement is a real challenge for thepeople of the Barents region. Integrationof the information network of OHS couldtherefore be acknowledged as one of mainpriorities in the follow-up programme ofinternational co-operation in the Euro-Arcticregion.All Russian participants of the seminarwere grateful to the Swedish colleaguesfor the vast information on theactivitiesy and skills of the Swedish OccupationalHealth Services.44 Barents Newsletter on Occup Health and Safety 1999;2:44


Strategies to preventTOBACCO SMOKINGamong adults in KareliaN Dorshakova, O Barsukova, K Nagovitsina, A SukalskyDepartment of Internal Medicine, Petrozavodsk State University, KareliaIt is well known that today tobaccosmoke is the main domestic pollutant.People have used tobacco in manyforms for centuries or even for thousandsof years. Tobacco was brought to Europefrom South America in the 16th century.At first tobacco smoking was forbiddenby the Church and the government, buttobacco smoking nevertheless soon becamea widespread habit among Europeans.Since the 17th century tobacco hasbeen grown for commercial purposes.For a long time the British colonies inNorth America were the chief exportersof tobacco to Europe. Before the 20thcentury, the most popular forms of tobaccoconsumption were pipes, cigars, andnon-smoking forms of tobacco such aschewing tobacco and snuff. But the realboom in the tobacco industry began atthe beginning of the 20th century as aresult of the widespread advertising campaignslaunched by the cigarette industry.(1)The analysis of the worldwide consumptionof tobacco products revealstheir constant increase during 1920–1960. It seemed that this increase wouldnever stope. But in 1951 two British doctors,Doll & Hill, published the resultsof their study, in which they claimed thatcigarette smoking is one of the major riskfactors of developing lung cancer. Duringthe next decade several studies publishedin the UK and the USA proved thatnicotine and tobacco tars are the maincause of lung cancer. This news broughtabout some changes in the smoking habitsof the people. Filter cigarettes appearedand they became very popularamong smokers. In some countries themaximal level of tars and nicotine waslimited.Today we know that lung cancer isnot the onlyhealth hazard of smoking. Theratio between mortality from lung cancerand other diseases attributable tosmoking is 1:2 or even 1:3.More than 4 000 chemical compoundshave been found in cigarettesmoke. Many of them are known to bepharmacologically active, toxic, mutagenic,and carcinogenic. There are 43known carcinogens in cigarette smoke.Lung cancer and cancer of the upper respiratorytract (nasal cavity, oral cavity,larynx and pharynx) are the most frequentconsequences of smoking. (According tothe data of the Dartmouth Medical Center,92% of the tumours of the oral cavityare caused by tobacco.) The second mostfrequent health hazards are chronic obstructivepulmonary diseases, such asemphysema, asthma and bronchitis.Smokers have the highest incidence ofcancer of any other localisation as well.The influence of smoking on thecardio-vascular system was discovered alittle later. It has been proven that cigarettesmoking increases the heart rate,blood pressure and irregular heart beat.The level of HDL cholesterol decreasesand the level of cholesterin and LDL cholesterolin the blood increases as the resultof smoking. These changes maycause atherosclerosis. Taken together,these factors are responsible for ischemicheart disease (IHD). According to thestudy carried out in 1962–1978 amongHarvard university students, the risk ofdeveloping IHD was 68% higher insmokers than in non-smokers. The incidenceof stroke was 52% higher in smokersand for other cardio-vascular diseasesthe risk was almost double.Smoking causes constriction of theblood vessels, thus complicating and aggravatingdiabetes, endarthritis and otherdiseases of the peripheral vessels, andit may also cause male impotency. Allthese factors make smoking the largestsingle factor of premature death. Accordingto the data of the American CancerSociety’s second Cancer PreventionStudy, only in the industrialized countriesalone, smoking caused 1.7 million deathsin 1985, 2.1 million in 1995 (and thusaltogether about 21 million in the1990s).It has been estimated that during the1990s in the industrialized countries 30%of the deaths of people aged 35–69 yearswill be due to tobacco. Those killed bytobacco at the age of 35–69 lose on averageabout 23 years of life.The above mentioned study suggeststhat if the current smoking patternsprevail, just over 20% of those now livingin the industrialized countries willeventually be killed by tobacco (about250 million out of the current total populationof just under one and a quarterbillion). (2)Such large-scale epidemiologicalstudies have been done mainly in theUnited States recently. There may be aneed for similar studies in Eastern Europe.In 1996 we carried out a screeningstudy of the Karelian population in orderto find out the role of tobacco smokingas a risk factor of pulmonary diseases.Altogether 5 628 people, who livemainly in Petrozavodsk, Belomorsk, Kostomukshaand Ladva village of the Prjaginskiregion, participated in the study.Barents Newsletter on Occup Health and Safety 1999;2:45–4645


Figure 1. Proportion of smokers in KareliaFigure 2. The smoking rates in each age group of the respondentsSome of the questionnaireswere omitted forvarious reasons, so the totalnumber of respondentscame to 5 054. Thisis about 0.7% of thepopulation of the Republic,which is enoughfor reproducible publicepidemiological studiesaccording to the WHOcriteria.In the present study 35% of the studypopulation were males. Nearly half ofthem were habitual smokers (46%), 25%had quit smoking, and only 29% of thererpondents had never smoked. Smokingwas less popular among women: only 7%of them smoked, 78% were never-smokersand 15% had quit smoking more thana year ago. These figures probably do notreflect the actual situation in the region,because the questionnaire was not anonymous.So, the percentage of femalesmokers might be significantly higher.These data indicate that the highest smokingrate (58%) in this region was amongpersons aged 30–39 years, a time whenthe tobacco addiction is usually strongand it is quite difficult to quit smoking.Within 20 minutes of smoking thelast cigarette, the heart rate and bloodpressure subside to their normal values.The carbon monoxide content in theblood falls, and the oxygen content risessimultaneously during the following 8hours. It is easier to give up smoking ifyou keep in mind that the possibility ofacute heart attack and myocardial infarctionis significantly lessened in personswho have stopped smoking. Within thenext 24 hours the nerve endings are restored,and the senses of smell and tastehave improved. The bronchial musclesrelax after two weeks, and breathing becomeseasier. This effect is even morepronounced in patients with chronic obstructivelung diseases. Unfortunately,they are very often smokers.About 1–3 months after stoppingsmoking, the circulation improves andthe pulmonary function reserve increasesup to 30%. In 1–9 months coughing,shortness of breath and fatigue lessen,and the tolerance to infections rises. And,you can save nearly 650 dollars a year(if you used to smoke a pack per day). 5years after you quit smoking your risk ofacute myocardial infarction and strokedevelopment is the same as in nonsmokers.Furthermore, lung cancer risk hasdropped to one half compared to habitualsmokers. Abnormal cells will be replacedin 10 years, and the risk of othercancers becomes the same as among never-smokers.(3)A large proportion of smokers(42%) are young people aged 18–20years. In our opinion, antismoking measuresshould be directed at this group, firstof all, because tobacco addiction in thisage group is usually not as strong as inthe other age groups. Such measureswould help to reduce the frequency ofpulmonary diseases, which are now in 4 thplace among the causes of mortality inKarelia (4). In order to prevent smoking inthis age group, 4 years ago we launched along-term programme called “Kareliawithout tobacco smoke”in some Petrozavodskschools, in cooperationwith Professor Ellis Rolettand Catherine Coborn,students of the DartmouthMedical College, andThe American OncologicSociety. Now antismokinglessons are given as a partof the programme “Thebasics of life security” in every Karelianschool. But this is not all: we feel that it isimportant to start prevention activitieseven before the child is born. An antismokingcampaign is carried out amongpregnant women and a brochure on thetopic will be published. At the same time,habitual smokers also need help. Antismokingsessions are held in some clinics,especially in the cardiological andpulmonological departments. A futureperspective would be to consult those whowant to quit smoking, by using the sourcesof the Internet.References1. Laurence DR, Bennett PN. Clinicalpharmacology. Moscow: Medicine, 1993.2. Peto R, Lopez AD, Boreham J, ThunM. Mortality from tobacco in developedcountries: indirect estimationfrom national vital statistics. Lancet1992;3:vol 339.3. Samet JM. Health benefits of smokingcessation. Clinics in Chest Medicine1991;4:vol 12.4. Dorshakova NV. Quality of the environmentand health. Petrozavodsk,1997.46 Barents Newsletter on Occup Health and Safety 1999;2:45–46


Aspects ofwomen’s occupational health andsafety protectionExperiences and tasks of the State Sanitary-Epidemiological ControlCentres in Murmansk CountyNatalia Yu. Yevdokimova, Yury A. Pogorely, RussiaWomen represent 52% of theworkers in Murmansk County, in addition to their majorrole of raising children. That is why thehygienists of the regional network of theState Sanitary-Epidemiological ControlCentres (SSECC) concentrate permanentlyon women’s occupational healthand safety, taking into consideration thephysiological characteristics of women.The SSEC Centres are conducting the“National Action Plan for the Promotionof Women’s Status and Improving TheirRole in Society in 1996–2000” approvedby the RF Decree No. 932 (1996). Theactions are regulated by the special GovernmentalResolution No. 1032 (1996)as well as the National Hygienic Standards(1996) “Hygienic Requirements ofLabour Conditions for Women”.Presently an evaluation of theworking conditions is being conductedin all workplaces in Murmansk County.One of the central goals of the project isan inventory of women’s workplaces withharmful and hazardous working conditions.The findings indicate that a specialprogramme has to be launched totransfer women from unfavourable workenvironments to safer ones through appropriatere-education and training.During the transition period thenumber of women employed in industryfell to 53.3%, but of these women, theproportion of those working in hazardousconditions has risen to 27.8% at theend of 1998 (an increase of 10.3%).There has also been an increase in thenumber of diseases causing temporaryand/or premature disability.Nevertheless, in 1996–1998 thepercentage of occupational morbidityamong working women was lower inMurmansk County than the mean valuesfor Russia: i.e., 17.1–18.3% vs 21–22.4%of the total numbers of cases. Diseasesof the locomotive system due to overexertionor physical over-loading predominated(48–50%). Previously thesedisorders were usually noted among fishprocessorsand painter-plasterers, but inthe past few years women working infood-processing and the light industry, aswell as health care sector (doctor-stomatologistsand masseurs) have also hadthese problems. Diseases caused bychemical agents (bronchial asthma,chemical bronchitis, eczema) are secondin order (33–35%). This group of diseasesis typical to painters and female smelters.Industrial dusts and aerosols cause12% of the occupational diseases ofworking women (bronchitis, pneumofibrosis).For a long time the SSEC Centreshave held to the policy of removing womenfrom occupations involving vibrationas an impact factor. As a result, the casesof vibrational pathology among womenare uncommon nowadays. Women do notwork in such tasks or with such equipmentwhich cause vibration (total or local)exceeding the occupational exposurelimits. Even in the cabins of trolleybussesand small trucks where womendrivers common, the control measurementsof vibration have conformed to thehygienic standards.As shown in the Annual SSEC Reportof 1998, the employment situationof women in Murmansk County can beillustrated as follows:• SSECC surveyed 6 271 workplacesemploying women (4 107 of them wereprivate enterprises)• 1 511 workplaces (including 1 179 private)(24.1%) had special funds to financelabour protection measures• An unfavourable work environmentwas found at 130 women’s workplaces(2.1%), of which 23 were private(0.56%)• The managers of 34 workplaces(0.54%), of which 33 were private, didnot comply with the National HygienicStandards when they employed somewomen without carrying out the obligatorymedical examinations by a therapistand gynaecologist• No cases of neglecting Orders Nos. 90and 555 of the Russian Ministry ofPublic Health (obligating employers toarrange prophylactic medical examinationsfor women about to begin workwith harmful occupational factors)have been recorded• 31 workplaces (0.49%), of which 2were private (0.05%), have sanitaryhygieniccertificates for women’s permanentworkplaces, and now the certificationof work-sites with safe workingconditions is in progress in the region• In 1997–1998, pregnant women werenot working in conditions prohibitedby the National Hygienic Standards inany of the surveyed workplaces.Some employers have been punishedfor violating the National HygienicStandards: 55 employers were finedin 1997 and 82 in 1998; 20 managerswere notified in 1997 and 42 in 1998;the SSEC Centres approved 6 resolutionsBarents Newsletter on Occup Health and Safety 1999;2:47–4847


Dr. Natalia Yevdokimovain 1997 and 16 in 1998 to suspend workplaceswith unfavourable occupationalhygienic conditions until improvement ofthe work environment according toStandards.• Also many state and private enterprisesexploit women employed in nightor shift work, e.g.:• the food industry – bakers in breadbakingplants and mini-bakeries• the health care sector (work in hospitalsand ambulance subdivisions, doctors,paramedical and junior medicalstaff)• hotels, hostels, restaurants – administrators• municipal services – control and securityofficers, operators• communication services with a daynightcycle – telephone operators, telegraphists• day-night trade enterprises – sales personnel.The National Hygienic Standards(1996) considers night-shift work to be anon-permissible load on the female organism.In reality, however, the prohibitionof female labour in the above branchesof economy would have many negativeconsequences, for instance the eliminationof medical services at night, thebreak-down of twenty-four-hour communication,etc. On the other hand, it wouldincrease unemployment among women.In regard to this contradiction, the SSECCentres usually make appropriate decisionsbased on the RF Labour Code,which prohibits only women with babiesto work night shifts.At present, the socio-economicconditions in small enterprises are suchthat the work is characterized by significantpsycho-emotional and intellectualload irrespective of the enterprise’s profile.The increased intensity of work processes,and high responsibility for finalresults, are now typical for both hiredworkers and employers. Work in a smallbusiness in today’s market economy requiresa higher level of physical and mentalhealth from the workers than earlier.Furthermore, the widespread use of personalcomputers and modern technologyin all spheres of activity have brought upthe needs to study the impact of these newfactors on the health of working women.Summarizing, we conclude that inorder to achieve the main goals of the«National Action Plan» the SSEC Centreshave to follow two main lines of action:first, the traditional and rigid controlof women’s work environments establishedin the National hygienic Standards,and second, the study of the workingconditions and new risk factors insmall enterprises and health care establishmentsusing modern electronic equipmentor methods of diagnosis and treatment(e.g. ultrasonic, laser and electromagneticradiation).Natalya YevdokimovaHead of the Department ofLabour Hygiene,Regional Centre for Sanitary-EpidemicControl in Murmansk CountyYuri PogorelyMain State Sanitary Inspector forthe Murmansk County,Honorary Doctor ofthe Russian Federation,Corresponding Member of the RussianAcademy of Natural Sciences7, Commune street, Murmansk 183743Russiaphone/fax +7 8152 474070XVWorld CongressonOccupationalSafety and HealthThe International Labour Organisation andthe International Social Security Associationarranged the XV World Congress on OccupationalSafety and Health, in São Paulo, Brazilon 12–16 April 1999. A total of 2,300participants from more than 70 countries attendedthe meeting. The Congress was organizedby the Ministry of Labour, throughthe Secretariat on Occupational Safety andHealth and FUNDACENTRO. The XVIWorld Congress will be held in Vienna, Austriain 2002.The meeting covered a wide range oftopics, structured around the followingthemes: ‘Safety, health and environment – Aglobal challenge’; ‘Impact of globalization’;‘Questions arising from globalization’;‘Common perspectives for safety, health andenvironmental protection in agriculture andforestry’; ‘Managing chemical risks’; ‘Roleand obligations of governments in the frameworkof globalization’; ‘Implementation ofoccupational safety, health and environmentalprotection’; ‘Information technologies:Opportunities and challenges within anevolving global environment’; ‘Economic incentivesfor the state and self-regulated occupationalsafety and health systems in mining’;‘Occupational safety and health inhealth services’; ‘New economic structuresand small and medium-sized enterprises’;‘Occupational safety and health in construction’;‘Training for the assessment of safetyand health risks’; ‘Management of occupationalsafety and health’; ‘Psychosocial issuesand ergonomics’; ‘Research applied toprotect man at work and the environment: Relationshipsand complementary issues’;‘Dock work and transport’; ‘Child labour’;and ‘Women and gender issues related to occupationalsafety and health’.At the Opening Session of the Congress,Dr. Jukka Takala of the ILO presentedsome facts and figures on occupational safetyand health that made his listeners sit upand think: 250 million occupational accidentsoccur every year, 1.1 million of them fatal.As occupational accidents are preventable,this is not only a great human tragedy butalso huge economic loss, he said.48Barents Newsletter on Occup Health and Safety 1999;2:47–48


WOMENin the world of workSuvi Lehtinen, FinlandIn connection with the XV WorldCongress on Occupational Safety and Health, the author had an opportunityto talk with women from manyparts of the world and to discuss withthem the most topical issues and urgentneeds in the development of women’swork in various countries and on differentcontinents. This collection of interviewswill provide the reader with aglimpse of the varied situations andproblems associated with the work ofwomen throughout the world. Close to200 participants were interested in thetopic and attended the Session on Womenand gender issues related to occupationalsafety and health in São Paulo,Brazil.Through alleviation ofpoverty to better healthDr. Erica Malekia, Medical Advisor onWorkers’ Health to the Tanzania TradeUnions, emphasizes the role of women’swork in Africa. She sees a lack of knowledgeof the risks involved in their workas the greatest problem facing women;and in many cases, women are forced toaccept poor working conditions becausethey badly need the money from theirjobs to sustain their families. A great dealof information support and training isalso needed, says Erica Malekia. Suchactivities are, however, well under way.The international organizations, such asthe ILO and WHO, have provided numerousguidelines and instructions, e.g.in the form of International Conventionsand Guidelines, she continues. In addition,both trade unions and the employers’associations have organized variousseminars and workshops aimed at increasingawareness. Such means are notsufficient, however, if the structures supportingoccupational health and safetyDr. Erica MalekiaDr. Maritza TennasseePHOTOS BY SUVI LEHTINENservices are lacking. Therefore, strengtheningof infrastructures is vital.Women often work in small-scaleindustries, such as farming, households,and contruction work, which involvemany problems and hazardous exposures.The most important issue in thedevelopment of women’s health is ensuringemployment and thereby the alleviationof poverty, because these constitutethe prerequisites for improvements inoccupational health and safety, says Dr.Malekia. She urges the various organizationsin the field of occupationalhealth and safety to continue their work,which in some instances has alreadyborne fruit.The role of the government is tosome extent difficult because of the largenumber of initiatives and actions neededin a developing country. Furthermore,the pressures for change in an ever moreintegrated world are enormous, andmany people tend to forget the strengthof national and local traditions, says EricaMalekia. It would be wise to keepone’s own traditions but at the same timeto adapt smoothly to the changing world,she concludes.Women – an importantresource in working lifeDr. Maritza Tennassee of the Pan-AmericanHealth Organization (PAHO) seesthe role of women in the countries ofthe Region as being very important.From the 1960s to the 1990s, the numberof women participating in working lifein the Americas has grown from 18 millionin 1960 to 57 million in 1990.The problems and challenges pertainingto the health of working womenin the Americas are associated with boththe major changes in the labour marketand the new production modes – suchas the maquila (export processing zonesor free trade zones) – that have comeabout with globalization of the economy.We have seen an important growthin the informal sector of the economy;today, out of every 100 jobs created, 85are in the informal sector, she says. Aconsiderable proportion of this growthBarents Newsletter on Occup Health and Safety 1999;2:49–5049


is the outcome of incorporating womeninto the workforce. During recent decades,high unemployment rates, underemployment,and the drop in households’real income have forced women onto thelabour market, where they have often takenhazardous, low-paid jobs, without legaland social protection or coverage byoccupational health services. Women’saverage wages are 20 to 40 per cent lowerthan those of men. Nor do culturalenvironments favour the promotion ofwomen to top managerial positions.During the last two decades, mostof the measurable growth in women’seconomic activity has occurred in urbanareas, where an average of 40 per cent ofwomen in Latin American countries, areactive in working life. On the other hand,the economic activity of women in ruralareas is often underestimated because ofthe manner in which employment data arecollected. Women’s work in rural areasis characterized by unpaid family work.Because this unpaid activity is not partof the cash economy, these women areclassified as economically inactive. Between50 and 60 per cent of women inthe countries round the Andes Mountains,in Mexico and in NE Brazil fall into thiscategory.Employment of women in lowpaid,hazardous jobs has had importantconsequences. First of all, these womenusually shoulder a double or triple burden:they work; they are responsible forthe family’s income; and they take careof the family. The risk factors they face –psychological, social, physical, chemical,ergonomic and others – lead to serioushealth effects among women. One majorobstacle is a lack of data on the healthoutcomes of economic activity in general,and the situation is even more severeamong women, says Dr. Maritza Tennassee.The social security institutes customarilyresponsible for data on health effectsdo not cover most working women.Occupations that are often studied withregard to workers’ health – mining, constructionwork, and heavy metal industrywork, for instance – are usually predominantlymale occupations, Dr. Tennasseeconcludes.New challenges in addition tothe old onesDr. Dulce P. Estrella-Gust works as ExecutiveDirector in the OccupationalSafety and Health Center of the Departmentof Labour and Employment in thePhilippines. She emphasizes the importanceof women’s work in the Asian Region.The Department of Labor and Employmenthas identified seven prioritygender issues in the Philippine workplace(see the article on page 46). The mainDr. Dulce P. Estrella-Gustprinciple is the protection of vulnerablegroups. Estrella-Gust stresses the importanceof integrating gender issues into theagenda of various organizations, bothprivate and public. “In 1997, we laid thefoundations for integrating gender intoour technical work, which includes research,training, advocacy and consultancy”,she says. “In 1998, critical items onour research agenda were to map out occupationalsafety and health issues concerningwomen, including multiple rolesand the burden of female workers, as wellas women’s exposure to toxic substances.In consultation with our social partnersand NGOs, we identified and prioritizedissues that impact on the safety andhealth of the Filipina worker. It is veryimportant to join forces”, she continues.“We are working closely with the ILO-IPEC in Manila to address the problemsof female children, dealing with all formsof exploitation, including sexual abuse.The Center acts as resource in the Healthand Safety Programme of the Trade UnionCongress of the Philippines (TUCP),one of the biggest trade unions in thecountry. In October this year, we will holda ‘National Symposium on Women in theWorkplace: Issues on Safety and Health’,which will bring together various practitionersand institutions. In addition tocollaboration at both the national andinternational levels, legislative actionsare needed to protect the most vulnerablegroups. An additional problem is totransform the legislation into practicalaction at workplaces”, Dr. Estrella-Gustpoints out.Suvi LehtinenFinnish Institute of OccupationalHealthTopeliuksenkatu 41 a AFIN-00250 helsinkiFinland50Barents Newsletter on Occup Health and Safety 1999;2:49–50


Work tasks that strain the eyesof workers (e.g. computer display operations, microscopicinvestigations, watch assembling, makingof jewellery, etc.) require specialcharacteristics of the performers, such asdiligence and precision. These characteristicsare more common in women. Thatis why women are usually employed inthe above-mentioned occupations.Two groups of women, aged 21–43 years and workingin conditions of highstrain on the visionwere chosen for thecase studies. The firstgroup consisted of theemployees in banksand in tax inspectionusing visual displayterminals; the secondgroup were assemblersof chips workingwith a microscope.According to the hygieniccriteria (1) theformer group relatedto class 3.2, and the latter to class 3.1. Inthe eye examinations of the workers, thefunctional status of the rod apparatus ofthe reticular retina and the photosensitivitycalculated from the time of adaptationto darkness was investigated withan adaptometer ADM. The time for discerninga test object after two minutes’adaptation to light from the internal surfaceof the adaptometer sphere (standardbrightness of 795 cd/m 2 and constantbrightness of the test object 0.0056 cd/m 2 ) was used as the main measurableparameter (2). The examination was conductedon Monday, Wednesday and Fridayon the first, fourth and eighth workhours. The results are presented in Table1.Analysis of the data shows an authenticsignificant decrease in photosensitivityduring the fourth hour of workingas evidenced by comparing appropri-Prophylaxis of visual fatigueof female workersunder high visual strainN. Malkova, RussiaTable 1. The mean time (in seconds) of the subjects’ adaptation to darkGroup 1st hour 4th hour 8th hour1 35.6+2.7 51.4+3.2 47.3+3.62 32.1+1.6 46.3+2.4 38.8+1.8Control 26.6+2.6 28.4+3.1 32.3+1.9Table 2. The time (in seconds) of the subjects’ adaptation to the dark afterlaser treatment to relieve visual fatigueGroup 1st hour 4th hour 8th hour1 33.5+2.6 36.8+1.9 37.1+2.32 29.2+2.3 34.1+2.6 32.9+2.6ate data in the central column with thosein the left one. At the end of the workday, on the eighth hour, increased photosensitivitywas noted, but not as clearlyas during the mid-day. In the controlgroup the subjects worked in optimallighting conditions without strain on theirvision; their photosensitivity levels fellslightly, the mean values being less thanin groups 1 and 2 by 16–80%. Workwhich strained the vision increased visualfatigue drastically, compared to thework in optimal conditions when the visionwas not strained. Therefore, the simplestway to lessen the negative impactof visual strain is to arrange optimal lightingat the work sites, as well as to followa rational plan for the work day, by alternatingthe stressful operations and restpauses and routine work.In addition to a rational plan, anactive method to combat visual fatiguewas suggested in 1989 by the author. Themethod is based on the effect of a lowintensivescattered laser emission on theretina. In order to relieve the fatigue duringthe fourth working hour, the workersare asked to look for two minutes at somedynamic pictures displayed in a hollowsphere by red laser beam reflected andmultiplied from the shells of the sphere.As a concerted effect of this procedure,the blood supply in the eye (including thereticular retina and pigmented epithelium)improves, and the metabolic processesare activated, thus improving thevision.The method was tested in studygroups 1 and 2, and the results are presentedin Table 2.The 5-day laser treatment courseto relieve fatigue stabilized the thresholdof photosensitivity during the workday, and enabled the workers to retain sufficientlyhigh visualcapability duringthe entire 8-hour shift. The improvedvision waspreserved after the5-day course for thefollowing 35 days,after which the visionslowly returnedto the baseline levelduring the next 3months, when thetreatment could berepeated with thesame positive effect.The laser method can thus be recommendedas an effective means to activelyprevent visual fatigue. In addition,the routine measures based on optimizingthe lightening, and also the rationalplanning of operation/rest cycles for femaleworkers working under high visualstrain.References1. Hygienic criteria for evaluating workingconditions in respect to hazards andrisk factors, load and strain, P2.2013-94. M. : Gossanepidemnadzor, 1994.42 p. (in Russian).2. Avetisov EC (Ed.). Handbook on ophthalmology.M. Medicina, 1978. 376p. (in Russian).Barents Newsletter on Occup Health and Safety 1999;2:5151


Òðàíñãðàíè÷íîåðàñïðîñòðàíåíèå îïûòà âîõðàíå òðóäà ñåðåðÿíÝììà Íèêèòèíà, ÐîññèÿÍà÷èíàÿ ñ ìàÿ 1995 ãîäà,Êîìèòåò ïî òðóäó, çàíÿòîñòèè ìèãðàöèè íàñåëåíèÿÀäìèíèñòðàöèè Ìóðìàíñêîé îáëàñòè(Îáëêîìòðóä) àêòèâíî ñîòðóäíè÷àåòñ àíàëîãè÷íûìè ñëóæáàìè äðóãèõîáëàñòåé Áàðåíö ðåãèîíà ñ öåëüþóëó÷øåíèÿ ñèñòåìû îõðàíû òðóäà.Äëÿ îáìåíà îïûòîì â Ìóðìàíñêåáûëè ïðîâåäåíû ðàáî÷èå âñòðå÷è èñåìèíàðû ñ ðåãèîíàëüíûìè ñëóæáàìèîõðàíû òðóäà ïðîâèíöèé Ôèííìàðêè Òðîìñ (Íîðâåãèÿ), ãóáåðíèèËàïëàíäèÿ (Ôèíëÿíäèÿ), â ðåçóëüòàòåêîòîðûõ áûëè ïîäïèñàíû äîãîâîðûî ðåàëèçàöèè ñîâìåñòíûõ ïðîåêòîâ.Îäíèì èç íèõ áûë ïåðâûé â íàøåéîáëàñòè ìåæäóíàðîäíûé ñåìèíàð ïîìåòîäàì ïðîôèëàêòèêè ïðîôçàáîëåâàíèéè íåñ÷àñòíûõ ñëó÷àåâ íàïðîèçâîäñòâå, ñîñòîÿâøèéñÿ â ñåíòÿáðå1997 ãîäà â ã. Àïàòèòû â Ìåæäóíàðîäíîìöåíòðå ïî ðàçâèòèþ íàóêè,êóëüòóðû è îáðàçîâàíèÿ â Áàðåíöðåãèîíå.Êîíòàêòû ñî øâåäñêèìè ïàðòíåðàìèàêòèâèçèðîâàëèñü ïîñëå ïðèñîåäèíåíèÿê Áàðåíö ðåãèîíó Âåñòåðáîòòåíà.24-25 ñåíòÿáðÿ 1998 ãîäà âÌóðìàíñêå ïî èíèöèàòèâå ØâåäñêîãîÍàöèîíàëüíîãî Óïðàâëåíèÿ ïðîôåññèîíàëüíîéáåçîïàñíîñòè è çäîðîâüÿè Ìóðìàíñêîãî Îáëêîìòðóäàáûë âïåðâûå ïðîâåäåí ðîññèéñêîøâåäñêèéñåìèíàð ïî ïðîáëåìàìïðîèçâîäñòâåííîé ãèãèåíû è îõðàíûòðóäà íà ïðîèçâîäñòâå. ñåìèíàðå ïðèíÿëè ó÷àñòèå 22÷åëîâåêà, ïðåäñòàâëÿâøèå Ìèíèñòåðñòâîòðóäà Øâåöèè è ìóðìàíñêèåîðãàíèçàöèè : Îáëêîìòðóä, Ñîþçàïðîìûøëåííèêîâ è ïðåäïðèíèìàòåëåé,Îáëàñòíîé Ñîâåò ïðîôñîþçîâ,Ãîñóäàðñòâåííóþ èíñïåêöèþòðóäà, Êîëüñêóþ ÍÈË ãèãèåíû òðóäàè Öåíòð àäàïòàöèè ÷åëîâåêà íà Ñåâåðåïðè Êîëüñêîì íàó÷íîì öåíòðåÐîññèéñêîé àêàäåìèè íàóê.Ýêñïåðòû èç Øâåöèè ÀíäåðøÄæåïñîí, Ëåíà Åëîôññîí èÏåð-Àíäåðø Çèíãìàðê ïðåäñòàâèëèîáøèðíóþ èíôîðìàöèþ î çàäà÷àõ,ðîëè è ìåòîäàõ ðàáîòû Øâåäñêîéèíñïåêöèè òðóäà, î íàöèîíàëüíîéïîëèòèêå ïî îõðàíå è ãèãèåíå òðóäà,ïîäåëèëèñü áîãàòûì îïûòîì îðãàíèçàöèèñîòðóäíè÷åñòâà ìåæäó ðàáîòîäàòåëÿìè,ïðîôñîþçàìè è îðãàíàìèâëàñòè Øâåöèè, îõàðàêòåðèçîâàëèîñíîâû ñèñòåìû ñòðàõîâàíèÿîò íåñ÷àñòíûõ ñëó÷àÿõ è ïðîôåññèîíàëüíîéçàáîëåâàåìîñòè íà ïðåäïðèÿòèÿõØâåöèè.Âòîðîé äåíü ñåìèíàðà áûë ïîñâÿùåíîáñóæäåíèþ ïåðñïåêòèâ ðàñøèðåíèÿñîòðóäíè÷åñòâà ìåæäóØâåöèåé è Ìóðìàíñêîé îáëàñòüþ.Ïî ìíåíèþ ðîññèéñêèõ ó÷àñòíèêîâñåìèíàðà íàèáîëåå ïðèâëåêàòåëüíûìèè ýôôåêòèâíûìè ôîðìàìèâçàèìîäåéñòâèÿ ìîãëè áû ñëóæèòü:• îáìåí èíôîðìàöèåé è ñïåöèàëèñòàìè,ïðîâåäåíèå ñîâìåñòíûõñåìèíàðîâ;• èçó÷åíèå ìåòîäîâ èíñòðóìåíòàëüíîãîêîíòðîëÿ çà ñîñòîÿíèåì óñëîâèéòðóäà íà ïðåäïðèÿòèÿõ Øâåöèèè Ìóðìàíñêîé îáëàñòè ñ öåëüþèõ ãàðìîíèçàöèè;• èçó÷åíèå øâåäñêîé êîìïüþòåðèçèðîâàííîéìîäåëè Ðåãèñòðà íåñ÷àñòíûõñëó÷àåâ íà ïðîèçâîäñòâå èïðîôçàáîëåâàíèé ñ ïîñëåäóþùèìâíåäðåíèåì åå â Ìóðìàíñêîéîáëàñòè;• îêàçàíèå îðãàíèçàöèîííîìåòîäè÷åñêîéïîìîùè Êîíñóëüòàöèîííî-ìåòîäè÷åñêîìóöåíòðóîõðàíû òðóäà, ñîçäàííîìó ïðèÎáëêîìòðóäà äëÿ îêàçàíèÿ ïîìîùèÝììà Íèêèòèíà,Íà÷àëüíèê Îòäåëà îõðàíû òðóäàÊîìèòåò ïî òðóäó, çàíÿòîñòè èìèãðàöèè íàñåëåíèÿÀäìèíèñòðàöèè Ìóðìàíñêîéîáëàñòèïðåäïðèÿòèÿì â ïðîâåäåíèè àòòåñòàöèèðàáî÷èõ ìåñò â ðàìêàõòðåõñòîðîííåãî ñîãëàøåíèÿ è Ðåãèîíàëüíîéïðîãðàììû ïî îõðàíåòðóäà äà íà 1997-99 ãîäû;• èçó÷åíèå ôîðì è ìåòîäîâ âåäåíèÿíàäçîðíîé ðàáîòû â îáëàñòè îõðàíûòðóäà íà ìàëûõ è ñðåäíèõ ïðåäïðèÿòèÿõØâåöèè (ñ ÷èñëåííîñòüþäî 100 ÷åëîâåê ðàáîòàþùèõ);• èçó÷åíèå îñíîâ ñèñòåìû îáÿçàòåëüíîãîñîöèàëüíîãî ñòðàõîâàíèÿîò íåñ÷àñòíûõ ñëó÷àåâ íàïðîèçâîäñòâå è ïðîôçàáîëåâàíèéâ ãîñóäàðñòâåííûõ è ÷àñòíûõïðåäïðèÿòèÿõ Øâåöèè è Ìóðìàíñêîéîáëàñòè ñ öåëüþ ãàðìîíèçàöèè;Áîëüøîé èíòåðåñ âûçâàëè äîêëàäûïðåäñòàâèòåëåé Êîëüñêîãîíàó÷íîãî öåíòðà ÐÀÍ Ýëüâèðû Âëàñîâîéè Èðèíû Ïåðìèíîâîé ïî ïðîåêòàì«Èçó÷åíèå âëèÿíèÿ íà çäîðîâüå÷åëîâåêà ñåâåðíûõ ãåëèîãåîôèçè-÷åñêèõ ôàêòîðîâ ðèñêà» è «Ðàçðàáîòêàìåòîäîâ ïðèìåíåíèÿ ìåñòíûõýíòåðîñîðáåíòîâ äëÿ ðåàáèëèòàöèèïðè âîçäåéñòâèè ñâèíöà».Ñåìèíàð ïîêàçàë, ÷òî âîïðîñûîïòèìèçàöèè ñèñòåì îõðàíû òðóäà èïðîôåññèîíàëüíîãî çäðàâîîõðàíåíèÿïðåäñòàâëÿþò âçàèìíûé èíòåðåñ äëÿâñåõ æèòåëåé Áàðåíö ðåãèîíà, â ñâÿçèñ ÷åì çàäà÷ó ñîçäàíèÿ åäèíîãî èíôîðìàöèîííîãîïðîñòðàíñòâà ïîïðîáëåìàì îõðàíû òðóäà ìîæíî ñ÷èòàòüîäíèì èç ïðèîðèòåòîâ ïðîãðàììðàçâèòèÿ ìåæäóíàðîäíîãî ñîòðóäíè÷åñòâàâ Åâðî-Àðêòè÷åñêîì ðåãèîíå.Âñå ðîññèéñêèå ó÷àñòíèêè ñåìèíàðàáûëè èñêðåííå áëàãîäàðíûØâåäñêèì êîëëåãàì çà ïîëó÷åííóþîáøèðíóþ èíôîðìàöèþ î äåÿòåëüíîñòèÓïðàâëåíèÿ îõðàíû òðóäà èÒðóäîâîé èíñïåêöèè Øâåöèè.52Barents Newsletter on Occup Health and Safety 1999;2:52


Ãèãèåíè÷åñêèå àñïåêòû îõðàíû òðóäàæåíùèí â äåÿòåëüíîñòè öåíòðîâãîññàíýïèäíàäçîðà Ìóðìàíñêîé îáëàñòèÞ. Ïîãîðåëûé, Í. Åâäîêèìîâà, ÐîññèÿÂîïðîñû îõðàíû òðóäà èçäîðîâüÿ æåíùèí ïîñòîÿííîíàõîäÿòñÿ â öåíòðå âíèìàíèÿâðà÷åé-ãèãèåíèñòîâ Ìóðìàíñêîéîáëàñòè â ñâÿçè ñî çíà÷èòåëüíîéäîëåé æåíùèí â îáùåé ÷èñëåííîñòèðàáîòàþùèõ (52%), ôèçèîëîãè÷åñêèìèîñîáåííîñòÿìè æåíñêîãîîðãàíèçìà è ðîëüþ æåíùèí ââîñïèòàíèè äåòåé. Ñâîþ ðàáîòóïî ýòîìó âîïðîñó öåíòðûãîñóäàðñòâåííîãî ñàíèòàðíîýïèäåìèîëîãè÷åñêîãîíàäçîðàïðîâîäÿò â ñîîòâåòñòâèè ñ«Íàöèîíàëüíûì ïëàíîì äåéñòâèé ïîóëó÷øåíèþ ïîëîæåíèÿ æåíùèí èïîâûøåíèþ èõ ðîëè â îáùåñòâå äî2000 ãîäà», óòâåðæäåííûì ÓêàçîìÏðåçèäåíòà ÐÔ îò 18.06.96 ¹932 èÏîñòàíîâëåíèåì Ïðàâèòåëüñòâà ÐÔîò 29.08.96 ¹ 1032, à òàêæå âñîîòâåòñòâèè ñ ÑàíÏèÍ 2.2.055-96«Ãèãèåíè÷åñêèå òðåáîâàíèÿ ê óñëîâèÿìòðóäà æåíùèí». íàñòîÿùåå âðåìÿ íà ïðåäïðèÿòèÿõè â îðãàíèçàöèÿõ îáëàñòèïðîâîäèòñÿ àòòåñòàöèÿ ðàáî÷èõ ìåñòïî óñëîâèÿì òðóäà, â õîäå êîòîðîéíàðÿäó ñ äðóãèìè çàäà÷àìè îïðåäåëÿåòñÿ÷èñëåííîñòü æåíùèí, çàíÿòûõíà ðàáîòàõ ñ âðåäíûìè è òÿæåëûìèóñëîâèÿìè òðóäà, è ðàçðàáàòûâàþòñÿïðîãðàììû âûñâîáîæäåíèÿ,ïåðåîáó÷åíèÿ è çàíÿòîñòè íàäðóãèõ âèäàõ ðàáîò. ñîâðåìåííûõ ñëîæíûõñîöèàëüíî-ýêîíîìè÷åñêèõ óñëîâèÿõíåñìîòðÿ íà ðåçêîå óìåíüøåíèå÷èñëà æåíùèí â ïðîèçâîäñòâåííîéñôåðå (íà 53,3%), çíà÷èòåëüíî (íà10,3%) âûðîñ óäåëüíûé âåñ ðàáîòàþùèõâ íåáëàãîïðèÿòíûõ óñëîâèÿõòðóäà, íà êîíåö 1998 ãîäà ýòà öèôðàñîñòàâèëà 27,8%. Îòìå÷àåòñÿ ðîñòòÿæåñòè çàáîëåâàíèé ñ âðåìåííîéóòðàòîé òðóäîñïîñîáíîñòè è ïåðâè-÷íîãî âûõîäà íà èíâàëèäíîñòü.Ïðîôåññèîíàëüíàÿ çàáîëåâàåìîñòüðàáîòàþùèõ æåíùèíâ ïîñëåäíèå ãîäû (1996-1998) ñîñòàâèëà17,1-18,3% âñåé ñóììû ïðîôçàáîëåâàíèéïðè ñðåäíåðîññèéñêîìïîêàçàòåëå 21-22,4%. Ñðåäè äèàãíîçîâïðåîáëàäàþò çàáîëåâàíèÿ îïîðíîäâèãàòåëüíîãîàïïàðàòà (48-50%), ïàòîãåíåòè÷åñêèìôàêòîðîì äëÿ êîòîðûõÿâëÿþòñÿ ôèçè÷åñêèå ïåðåãðóçêè èïåðåíàïðÿæåíèå îòäåëüíûõ îðãàíîâ èñèñòåì. Ê òðàäèöèîííûì äëÿ ýòîéïàòîëîãèè ïðîôåññèÿì (ðûáîîáðàáîò÷èöû,øòóêàòóðû-ìàëÿðû) â ïîñëåäíèåãîäû äîáàâèëèñü ðàáîòíèöûëåãêîé è ïèùåâîé ïðîìûëåííîñòè,òàêæå ìåäèöèíñêèå ðàáîòíèêè (âðà÷èñòîìàòîëîãèè ìàññàæèñòû). Çàáîëåâàíèÿ,âûçâàííûå âîçäåéñòâèåì õèìè÷åñêîãîôàêòîðà (áðîíõèàëüíàÿàñòìà, õèìè÷åñêèå áðîíõèòû, ýêçåìà),ïî ñâîåé ðàñïðîñòðàíåííîñòè çàíèìàþòâòîðîå ìåñòî â îáëàñòè è ñîñòàâëÿþò33-35%. Ýòà ãðóïïà çàáîëåâàíèéõàðàêòåðíà äëÿ ìàëÿðîâ èðàáîòíèö ïëàâèëüíûõ öåõîâ. Ïðîìûøëåííûåïûëè è àýðîçîëè âûçûâàþò12% ïðîôçàáîëåâàíèé ðàáîòàþùèõæåíùèí (áðîíõèòû, ïíåâìîôèáðîçû). òå÷åíèå äëèòåëüíîãî âðåìåíèöåíòðàìè ãîñññàíýïèäíàäçîðà ïðîâîäèëàñüàêòèâíàÿ ðàáîòà ïî âûâîäóæåíùèí èç ïðîôåññèé, ãäå îñíîâíûìâðåäíûì ôàêòîðîì ÿâëÿåòñÿ âèáðàöèÿ. íàñòîÿùåå âðåìÿ ñëó÷àè âèáðàöèîííîéïàòîëîãèè ñðåäè æåíùèíïðàêòè÷åñêè íå ðåãèñòðèðóþòñÿ. Æåíùèíûíå ðàáîòàþò íà ó÷àñòêàõ èîáîðóäîâàíèè, ãäå óðîâíè âèáðàöèè(îáùåé è ëîêàëüíîé) ïðåâûøàþòïðåäåëüíî äîïóñòèìûå. Çàìåðû ïàðàìåòðîââèáðàöèè íà ðàáî÷èõ ìåñòàõâîäèòåëåé òðîëëåéáóñîâ è àâòîòðàíñïîðòàìàëîé ãðóçîïîäúåìíîñòè, ãäåèñïîëüçóåòñÿ òðóä æåíùèí, ïîêàçàëèñîîòâåòñòâèå ãèãèåíè÷åñêèì íîðìàòèâàì.Ïî èòîãàì 1998 ãîäà ñëåäóåòîòìåòèòü:• âñåãî îáúåêòîâ íàäçîðà, ïðèìåíÿþùèõòðóä æåíùèí, â îáëàñòè6271, â òîì ÷èñëå 4107 îáúåêòîâ÷àñòíîé ñîáñòâåííîñòè;• èìåþò ñïåöèàëüíûå ôîíäû äëÿôèíàíñèðîâàíèÿ ìåðîïðèÿòèé ïîîõðàíå òðóäà 1511 (24,1%), â òîì÷èñëå 1179 îáúåêòîâ ÷àñòíîé ñîáñòâåííîñòè(28,7%);• òðóä æåíùèí íà ó÷àñòêàõ ñ íåáëàãîïðèÿòíûìèóñëîâèÿìè òðóäàïðèìåíÿåòñÿ íà 130 îáúåêòàõ(2,1%), â òîì ÷èñëå íà 23 îáúåêòàõ÷àñòíîé ñîáñòâåííîñòè - (0,56%);äîïóñòèëè ïðèåì æåíùèí íà ðàáîòóáåç ìåäèöèíñêèõ îñìîòðîâòåðàïåâòîì è àêóøåðîìãèíåêîëîãîì34 ïðåäïðèÿòèÿ(0,54%), â òîì ÷èñëå 33 ïðåäïðèÿòèÿ÷àñòíîé ñîáñòâåííîñòè (0,8%);• ñëó÷àåâ äîïóñêà æåíùèí íà ðàáîòóñ âðåäíûìè ïðîèçâîäñòâåííûìèôàêòîðàìè áåç ïðîôèëàêòè÷åñêèõìåäèöèíñêèõ îñìîòðîâ â ñîîòâåòñòâèèñ ïðèêàçàìè Ìèíçäðàâà ¹ 90è 555 íå óñòàíîâëåíî;• ïðåäïðèÿòèé, èìåþùèõ ñàíèòàðíîãèãèåíè÷åñêèåïàñïîðòà íà ïîñòîÿííûåðàáî÷èå ìåñòà æåíùèí - 31(0,49%), â òîì ÷èñëå ïðåäïðèÿòèé÷àñòíîé ñîáñòâåííîñòè - 2 (0,05%); âíàñòîÿùåå âðåìÿ íà ïðåäïðèÿòèÿõîáëàñòè ïðîâîäèòñÿ àòòåñòàöèÿ ðàáî-÷èõ ìåñò ïî óñëîâèÿì òðóäà ñ îôîðìëåíèåìñîîòâåòñòâóþùèõ êàðò;• ïðåäïðèÿòèé, äîïóñòèâøèõ ðàáîòóBarents Newsletter on Occup Health and Safety 1999;2:53–54 53


áåðåìåííûõ æåíùèí â óñëîâèÿõ, íåðàçðåøåííûõ ÑàíÏèí 2.2.055-96, â1997-98 ã.ã. íå âûÿâëåíî. ñâÿçè ñ äîïóùåííûìè ðÿäîìðàáîòîäàòåëåé íàðóøåíèÿìè ïî óñëîâèÿìèñïîëüçîâàíèÿ æåíñêîãî òðóäà ïðèìåíÿëèñüìåðû àäìèíèñòðàòèâíîãî ïðèíóæäåíèÿ.Òàê, áûëè îøòðàôîâàíû â 1997ãîäó 55 ðóêîâîäèòåëåé, â 1998 - 82;ïðåäóïðåæäåíû â 1997 ãîäó 20 ÷åëîâåê, â1998 - 42: ïîñòàíîâëåíèé î ïðèîñòàíîâêåýêñïëóàòàöèè íåáëàãîïîëó÷íûõ ó÷àñòêîâáûëî âûíåñåíî â 1997 ãîäó 6 , à â 1998 -16.Ñëåäóåò îòìåòèòü, ÷òî âî âñåõ îòðàñëÿõõîçÿéñòâà íà ïðåäïðèÿòèÿõ âñåõ ôîðìñîáñòâåííîñòè èñïîëüçóåòñÿ òðóä æåíùèíâ íî÷íûõ ñìåíàõ:• ïèùåâàÿ ïðîìûøëåííîñòü - ïåêàðè íàõëåáîçàâîäàõ è â ìèíè-ïåêàðíÿõ;• ëå÷åáíî-ïðîôèëàêòè÷åñêèå ó÷ðåæäåíèÿ( ñòàöèîíàðû, áðèãàäû ñêîðîéìåäèöèíñêîé ïîìîùè) - âðà÷è, ñðåäíèéè ìëàäøèé ìåäèöèíñêèé ïåðñîíàë;• ãîñòèíèöû, îáùåæèòèÿ - àäìèíèñòðàòîðû;• ñëóæáû êîììóíàëüíîãî õîçÿéñòâà -äèñïåò÷åðû, îïåðàòîðû;• ïðåäïðèÿòèÿ ñâÿçè êðóãëîñóòî÷íîãîöèêëà - òåëåôîíèñòêè, òåëåãðàôèñòêè;• ïðåäïðèÿòèÿ òîðãîâëè ñ êðóãëîñóòî÷íûìðåæèìîì - ïðîäàâöû .• ÑàíÏèÍ 2.2.055-96 ðàññìàòðèâàåòðàáîòó â íî÷íûõ ñìåíàõ êàê íàãðóçêó,ïðåâûøàþùóþ äîïóñòèìóþ äëÿ æåíñêîãîîðãàíèçìà, îäíàêî çàïðåùåíèåæåíñêîãî òðóäà â óêàçàííûõ ñôåðàõïðèâåäåò, ñ îäíîé ñòîðîíû, ê ëèêâèäàöèèíî÷íîãî ìåäèöèíñêîãî îáñëóæèâàíèÿ,ôàêòè÷åñêîé îñòàíîâêåêðóãëîñóòî÷íîé ýëåêòðîñâÿçè è ò.ï.,à ñ äðóãîé ñòîðîíû, áóäåò ñïîñîáñòâîâàòüóâåëè÷åíèþ æåíñêîé áåçðàáîòèöû. ñâÿçè ñ óêàçàííûì öåíòðûãîññàíýïèäíàäçîðà îáëàñòè â îïðåäåëåíèèðåæèìà òðóäà ðàáîòàþùèõæåíùèí ðóêîâîäñòâóþòñÿ ÊÇÎÒîìÐÔ (ñò. 48, 161,162), îãðàíè÷èâàþùèìäîïóñê íà ðàáîòû â íî÷íûå ñìåíûòîëüêî æåíùèí, èìåþùèõ ìàëåíüêèõäåòåé. ñîâðåìåííûõ ñîöèàëüíîýêîíîìè÷åñêèõóñëîâèÿõ ðàçâèâàåòñÿïðåèìóùåñòâåííî ñôåðà ìàëîãî áèçíåñà,òðóä â êîòîðîé, íåçàâèñèìî îò óçêîéñïåöèôèêè ïðîèçâîäñòâà, õàðàêòåðèçóåòñÿçíà÷èòåëüíûìè ïñèõîýìîöèîíàëüíûìèè èíòåëëåêòóàëüèíòåëëåêòóàëüíûìèíàãðóçêàìè. Âîçðîñøàÿèíòåíñèôèêàöèÿ òðóäîâûõïðîöåññîâ, ïîâûøåííàÿ îòâåòñòâåííîñòüçà êîíå÷íûå ðåçóëüòàòû òðóäà õàðàê-Íàòàëüÿ ÅâäîêèìîâàÇàâåäóþùàÿ îòäåëåíèåì ãèãèåíûòðóäàÖåíòðà ãîññàíýïèäåìíàäçîðà âÌóðìàíñêîé îáëàñòèÞðèé ÏîãîðåëûéÃëàâíûé ñàíèòàðíûé âðà÷ ïîÌóðìàíñêîé îáëàñòèçàñëóæåííûé âðà÷ ÐÔ,÷ëåí-êîððåñïîíäåíò ÐîññèéñêîéÀêàäåìèè Åñòåñòâåííûõ Íàóê.Ìóðìàíñê 183743, óë. Êîììóíû, 7.Òåëåôîí / ôàêñ +7 8152 474070òåðíà ñåãîäíÿ êàê äëÿ íàåìíûõ ðàáîòíèêîâ,òàê è äëÿ ñàìèõ ïðåäïðèíèìàòåëåé.Òðóäîâàÿ äåÿòåëüíîñòü â ñèñòåìåìàëîãî áèçíåñà ñåãîäíÿ ïðåäúÿâëÿåòïîâûøåííûå òðåáîâàíèÿ ê óðîâíþîáùåãî ôèçè÷åñêîãî è ïñèõè÷åñêîãîçäîðîâüÿ ðàáîòàþùèõ. Øèðîêîå èñïîëüçîâàíèåâî âñåõ ñôåðàõ äåÿòåëüíîñòèïåðñîíàëüíûõ êîìïüþòåðîâ è äðóãîéýëåêòðîííîé îðãòåõíèêè òðåáóåò èçó-÷åíèÿ âëèÿíèÿ ýòèõ ôàêòîðîâ íà çäîðîâüåðàáîòàþùèõ, â òîì ÷èñëå è íà æåíñêèéîðãàíèçì.Òàêèì îáðàçîì, äëÿ äîñòèæåíèÿöåëåé, íàìå÷åííûõ «Íàöèîíàëüíûì ïëàíîìäåéñòâèé», öåíòðû ãîñóäàðñòâåííîãîñàíèòàðíî-ýïèäåìèîëîãè÷åñêîãî íàäçîðà âÌóðìàíñêîé îáëàñòè íàðÿäó ñ òðàäèöèîííûì,íî áîëåå æåñòêèì íàäçîðîì çàîáåñïå÷åíèåì óñëîâèé òðóäà ðàáîòàþùèõæåíùèí â ñîîòâåòñòâèè ñ äåéñòâóþùèìèñàíèòàðíî-ãèãèåíè÷åñêèìè íîðìàòèâàìè,äîëæíû àêòèâèçèðîâàòü ãèãèåíè÷åñêèåèññëåäîâàíèÿ íîâûõ ïðîèçâîäñòâåííûõôàêòîðîâ íà ïðåäïðèÿòèÿõ ìàëîãî áèçíåñàè â ìåäèöèíñêèõ ó÷ðåæäåíèÿõ, èñïîëüçóþùèõñîâðåìåííóþ ýëåêòðîííóþ àïïàðàòóðóè íîâåéøèå ìåòîäû äèàãíîñòèêè èëå÷åíèÿ (óëüòðàçâóê, ëàçåðíîå è ýëåêòðîìàãíèòíîåèçëó÷åíèå ðàçëè÷íûõ äèàïàçîíîâ).54Barents Newsletter on Occup Health and Safety 1999;2:53–54


Ñòðàòåãèÿ ïðåäóïðåæäåíèÿòàáàêîêóðåíèÿ ñðåäè âçðîñëîãîíàñåëåíèÿ ÊàðåëèèÍ.Â. Äîðøàêîâà, Î.Þ. Áàðñóêîâà, Ê.Â. Íàãîâèöèíà, À.À. ÑóêàëüñêèéÊàôåäðà ôàêóëüòåòñêîé òåðàïèè ÏåòðÃÓ, ã.ÏåòðîçàâîäñêÈçâåñòíî, ÷òî òàáàêîêóðåíèåñåãîäíÿ ÿâëÿåòñÿ ãëàâíûìáûòîâûì ïîëëþòàíòîì. ðàçíûõ ôîðìàõ òàáàê èñïîëüçîâàëñÿ÷åëîâå÷åñòâîì íà ïðîòÿæåíèèìíîãèõ âåêîâ, âîçìîæíî òûñÿ-÷åëåòèé. Êàê èçâåñòíî, òàáàê áûëçàâåçåí â Åâðîïó èç Þæíîé Àìåðèêèâ 16 âåêå. Ïî íà÷àëó êóðåíèå áûëîçàïðåùåíî è Öåðêîâüþ, è Ïðàâèòåëüñòâîì,íî âîïðåêè ýòîìó òàáàêîêóðåíèåâñêîðå ñòàëî øèðîêî ðàñïðîñòðàíåíîñðåäè Åâðîïåéöåâ. Ñ 17âåêà òàáàê ñòàëè âûðàùèâàòü â êîììåð÷åñêèõöåëÿõ, è íà ïðîòÿæåíèèäîëãîãî âðåìåíè Áðèòàíñêèå êîëîíèèâ Ñåâåðíîé Àìåðèêå áûëè ãëàâíûìèýêñïîðòåðàìè òàáàêà â Åâðîïó. Äî 20âåêà íàèáîëåå ïîïóëÿðíûìè ôîðìàìèïîòðåáëåíèÿ òàáàêà áûëè êóðèòåëüíûåòðóáêè, ñèãàðû, æåâàòåëüíûé èíþõàòåëüíûé òàáàê. Íî ïîèñòèíåíàñòîÿùèé áóì â òàáà÷íîé ïðîìûøëåííîñòèíà÷àëñÿ â 20 âåêå êàêðåçóëüòàò íåïðåðûâíîãî ðîñòà ñèãàðåòíîéèíäóñòðèè. (1)Àíàëèç ïîòðåáëåíèÿ òàáà÷íîéïðîäóêöèè â ìèðå ïîêàçàë å¸ ïîñòîÿííûéðîñò çà ïåðèîä ñ 1920ã.ïî 1960ã. Êàçàëîñü, íè÷òî íå ìîãëîïîâëèÿòü íà õîä ñîáûòèé. Íî â 1951ãîäó äâîå Áðèòàíñêèõ ó÷åíûõ Doll &Hill âïåðâûå âûñêàçàëè ïðåäïîëîæåíèåî ñâÿçè êóðåíèÿ è ðàêà. Çàòåìâ 1976 ãîäó ïðîñïåêòèâíîå èññëåäîâàíèåñðåäè áðèòàíñêèõ âðà÷åé ïîäòâåðäèëîïðàâèëüíîñòü ïðåäïîëîæåíèÿî òîì, ÷òî íèêîòèí è æèäêèåñìîëû ÿâëÿþòñÿ ãëàâíîé ïðè÷èíîéðàêà ëåãêèõ. Ýòî ïîâëåêëî çà ñîáîéíåêîòîðûå èçìåíåíèÿ êóðèòåëüíûõïðèâû÷åê íàñåëåíèÿ. Ïîÿâèëèñü ñèãàðåòûñ ôèëüòðîì, ñòàâøèå î÷åíüïîïóëÿðíûìè ñðåäè êóðèëüùèêîâ. Âíåêîòîðûõ ñòðàíàõ áûëè óñòàíîâëåíûïðåäåëüíî äîïóñòèìûå íîðìû ñîäåðæàíèÿæèäêèõ ñìîë è íèêîòèíà âïðîäóêöèè.Ñåé÷àñ ìû çíàåì, ÷òî ðàê ëåãêèõ- íå åäèíñòâåííîå ïîñëåäñòâèå òàáàêîêóðåíèÿ,íà êàæäóþ ñìåðòü îò ðàêàëåãêèõ ïðèõîäèòñÿ 2 - 3 îò äðóãèõçàáîëåâàíèé.  òàáà÷íîì äûìå îáíàðóæåíîáîëåå 4000 õèìè÷åñêèõ ñîåäèíåíèé,ìíîãèå èç êîòîðûõ ÿâëÿþòñÿôàðìàêîëîãè÷åñêè àêòèâíûìè, òîêñè-÷íûìè, ìóòàãåííûìè è êàíöåðîãåííûìè(43 êàíöåðîãåííûõ âåùåñòâàâûÿâëåíî â òàáà÷íîì äûìå). Ñðåäèïîñëåäñòâèé, âûçûâàåìûõ êóðåíèåì,íà ïåðâîì ìåñòå ñòîèò ðàê ëåãêèõ èâåðõíèõ äûõàòåëüíûõ ïóòåé (ðîòîâàÿïîëîñòü, ïîëîñòü íîñà, ãîðòàíü èãëîòêà (ïî äàííûì Dartmouth-Hitchcock Medical Center 92% îïóõîëåéðîòîâîé ïîëîñòè âûçâàíû êóðåíèåì).Âòîðûì ïî ÷àñòîòå ÿâëÿåòñÿ ðàçâèòèåõðîíè÷åñêèõ îáñòðóêòèâíûõ çàáîëåâàíèéëåãêèõ, òàêèõ êàê ýìôèçåìà,àñòìà è õðîíè÷åñêèé áðîíõèò. Âñòðå-÷àåìîñòü ðàêà äðóãèõ ëîêàëèçàöèéñðåäè êóðèëüùèêîâ òîæå âûñîêà.Î âëèÿíèè êóðåíèÿ íà ñåðäå÷íîñîñóäèñòóþñèñòåìó ñòàëî èçâåñòíîíåñêîëüêî ïîçäíåå. Äîêàçàíî, ÷òîòàáà÷íûé äûì âûçûâàåò óâåëè÷åíèå÷àñòîòû ñåðäå÷íûõ ñîêðàùåíèé,ñïîñîáñòâóåò ïîäúåìó àðòåðèàëüíîãîäàâëåíèÿ, âîçíèêíîâåíèþ àðèòìèè,â ðåçóëüòàòå êóðåíèÿ â êðîâè ïðîèñõîäèòñíèæåíèå ËÏÂÏ è ïîâûøåíèåËÏÍÏ è õîëåñòåðèíà, ÷òîñïîñîáñòâóåò ðàçâèòèþ àòåðîñêëåðîçà.Ïðè êóðåíèè ïðîèñõîäèò îáðàçîâàíèåóãàðíîãî ãàçà, êîòîðûé,ñîåäèíÿÿñü ñ ãåìîãëîáèíîì, ñíèæàåòêèñëîðîäíóþ åìêîñòü êðîâè. Âñåïåðå÷èñëåííûå ôàêòîðû âìåñòåâçÿòûå ñïîñîáñòâóþò ðàçâèòèþ ÈÁÑ.Ñîãëàñíî äàííûì èññëåäîâàíèÿ,ïðîâåäåííîãî ñðåäè ñòóäåíòîâ âÃàðâàðäñêîì óíèâåðñèòåòå â 1962 -1978, ðèñê âîçíèêíîâåíèÿ ÈÁÑ áûë íà68% âûøå ó êóðÿùèõ ïî ñðàâíåíèþ ñíåêóðÿùèìè, íà 52% - ïî èíñóëüòó èíà 100% - ïî äðóãèì ñåðäå÷íîñîñóäèñòûìçàáîëåâàíèÿì.Êóðåíèå âûçûâàåò ñïàçì ïåðèôåðè÷åñêèõñîñóäîâ êîíå÷íîñòåé, ÷òîóòÿæåëÿåò òå÷åíèå äèàáåòà, ýíäàðòåðèèòàè äðóãèõ çàáîëåâàíèé ïåðèôåðè÷åñêèõñîñóäîâ, à òàêæå ïðèâîäèòê èìïîòåíöèè.Âñå ïåðå÷èñëåííûå ôàêòîðûäåëàþò êóðåíèå îäíîé èç ãëàâíûõïðè÷èí ïðåæäåâðåìåííîé ñìåðòè âðàçâèòûõ ñòðàíàõ. Ñîãëàñíî äàííûìR.Peto è êîëëåã òîëüêî â ðàçâèòûõñòðàíàõ îò êóðåíèÿ óìåðëè 1,7 ìëí÷åëîâåê â 1985, 2,1 ìëí â 1995 è çàäåñÿòèëåòèå 1990-1999 óìðåò ïðèìåðíî21 ìëí. Òàêèì îáðàçîì, â 90-õãîäàõ òàáàêîêóðåíèå ñðåäè ëþäåé ââîçðàñòå 35 - 69 ëåò áóäåò ïðè÷èíîéîêîëî 30% ñìåðòåé, ÷òî îçíà÷àåò, ÷òîëþäè âîçðàñòà 35 - 69 ëåò â ñðåäíåìòåðÿþò îêîëî 23 ëåò æèçíè. Åñëèñåãîäíÿøíèé óðîâåíü ïîòðåáëåíèÿñèãàðåò ñîõðàíèòñÿ, áîëåå 20% èçíûíå æèâóùèõ â ðàçâèòûõ ñòðàíàõïîãèáíóò îò êóðåíèÿ (ò.å. ïðèìåðíî÷åòâåðòü ìèëëèàðäà èç 1 ìëðä 250 ìëííûíå æèâóùèõ). (2)Ê ñîæàëåíèþ, ïîäîáíûå ìàññîâûåèññëåäîâàíèÿ äî íàñòîÿùåãîâðåìåíè ïðîâîäèëèñü â îñíîâíîì âÑØÀ, íî âåðîÿòíî åñòü íåîáõîäèìîñòüâ ïðîâåäåíèè òàêîâûõ è â ñòðàíàõÂîñòî÷íîé Åâðîïû. 1996 ã íàìè áûëî ïðîâåäåíîñêðèíèíãîâîå èññëåäîâàíèå íàñåëåíèÿÊàðåëèè ñ öåëüþ âûÿâëåíèÿ÷àñòîòû òàáàêîêóðåíèÿ êàê ôàêòîðàðèñêà ðàçâèòèÿ áðîíõîë¸ãî÷íûõ çàáîëåâàíèé.Âñåãî â îáñëåäîâàíèå áûëèâêëþ÷åíû 5628 æèòåëåé Êàðåëèè, âîñíîâíîì ïðîæèâàþùèõ â ã. Ïåòðîçàâîäñêå,ïîñ¸ëêå Ëàäâà Ïðÿæèíñêîãîðàéîíà, ã. Áåëîìîðñêå è ã. Êîñòîìóêøà.×àñòü àíêåò ïî ðàçíûì ïðè÷èíàì áûëàçàáðàêîâàíà, ò.î. èòîãîâîå êîëè÷åñòâîBarents Newsletter on Occup Health and Safety 1999;2:54–5655


ðåñïîíäåíòîâ -5054 ÷å- ëîâåêà. Ýòîñîñòàâëÿåò 0,7 % âñåãîíàñåëåíèÿ ðåñïóáëèêè,÷òî ïî êðè- òåðèÿìÂÎÇ ÿâëÿåòñÿíåîáõîäèìûì è äîñòàòî÷íûìêîëè÷åñòâîìäëÿ äîñòîâåðíîãîýïèäåìèîëîãè÷åñêîãîèññëåäîâàíèÿ áîëüøèõïîïóëÿöèé íàñå- ëåíèÿ. ðàçðàáîòàííîé íàìè àíêåòåëèöà, êîòîðûå íèêîãäà íå êóðèëè,îïðåäåëÿëèñü êàê «íå êóðÿò».Îáñëåäîâàííûå, êîòîðûå ïðåêðàòèëèêóðèòü áîëåå 12 ìåñÿöåâ äî îïðîñà,êëàññèôèöèðîâàëèñü êàê «êóðèëè», àëèöà, êîòîðûå êóðÿò èëè áðîñèëèêóðèòü ìåíåå 12 ìåñÿöåâ íàçàä êàê«êóðÿò». íàñòîÿùåì èññëåäîâàíèèìóæ÷èíû ñîñòàâèëè 35% îò îáùåãî÷èñëà ðåñïîíäåíòîâ, ïðè ýòîì 46% èçíèõ îêàçàëèñü êóðèëüùèêàìè, â ïðîøëîìêóðèëè åù¸ 25%, è ëèøü 29% èçîïðîøåííûõ íå êóðÿò. Ñðåäè æåíùèíïðèâû÷êà òàáàêîêóðåíèÿ ìåíåå ïîïóëÿðíà:åé ïîäâåðæåíû òîëüêî 7%îïðîøåííûõ, òîãäà êàê 78% èç íèõ íåêóðÿò, è 15% æåíùèí ðàññòàëèñü ñýòîé ïðèâû÷êîé áîëåå 12 ìåñÿöåâíàçàä.Íî, ñêîðåå âñåãî, äàííûå öèôðûíå îòðàæàþò äåéñòâèòåëüíîéñèòóàöèè, ò.ê. àíêåòèðîâàíèå íåáûëî àíîíèìíûì è ïðîöåíò êóðÿùèõæåíùèí, âåðîÿòíî, çíà÷èòåëüíîâûøå.Ïî äàííûì íàøåãî èññëåäîâàíèÿíàèáîëüøèé ïðîöåíò êóðèëüùèêîâ(58%)â ðåãèîíå ïðèõîäèòñÿ íàñðåäíåâîçðàñòíóþ ãðóïïó (30-39 ëåò),êîãäà ñòåïåíü çàâèñèìîñòè îò òàáàêà,êàê ïðàâèëî, óæå äîâîëüíî âûñîêàÿ èîòêàçàòüñÿ îò ïðèâû÷êè òàáàêîêóðåíèÿî÷åíü ñëîæíî. Íî, âåðîÿòíî, ñòîèòïîïðîáîâàòü. Âåäü óæå ÷åðåç 20 ìèíóòïîñëå òîãî, êàê Âû çàòóøèëè ïîñëåäíþþñèãàðåòó ïóëüñ è ÀÄ ñíèæàþòñÿäî íîðìàëüíûõ ïîêàçàòåëåé.×åðåç 8 ÷àñîâ ñîäåðæàíèå óãëåêèñëîòûâ êðîâè ñíèæàåòñÿ äî íîðìàëüíîãîóðîâíÿ è îäíîâðåìåííî ïîâûøàåòñÿêîíöåíòðàöèÿ êèñëîðîäà. Íó à ïðîæèòü24 ÷àñà áåç ñèãàðåòû… Òàê ëèýòî òÿæåëî? Íàâåðíîå, íåò. Îñîáåííîåñëè çíàåøü, ÷òî óæå ÷åðåç äåíüâîçìîæíîñòü âîçíèêíîâåíèÿ ïðèñòóïàñòåíîêàðäèè, îñòðîãî èíôàðêòàìèîêàðäà ïî ñðàâíåíèþ ñêóðÿùèìè çíà÷èòåëüíî ñíèæàåòñÿ.Åù¸ ÷åðåç 24 ÷àñà âîññòàíàâëèâàþòñÿíåðâíûå îêîí÷àíèÿ, óëó÷øàåòñÿîáîíÿíèå, âêóñîâàÿ ÷óâñòâèòåëüíîñòüè ìèð âêóñîâ è çàïàõîâ âíîâü îêðóæàåòÂàñ. ×åðåç 2 íåäåëè ðàññëàáëÿþòñÿìûøöû áðîíõîâ, Âàìñòàíîâèòñÿ ëåã÷å äûøàòü. Îñîáåííîýòî ïî÷óâñòâóþò òå, êòî ñòðàäàåòîáñòðóêòèâíûì áðîíõèòîì, áðîíõèàëüíîéàñòìîé. Ê ñîæàëåíèþ, ýòèçàáîëåâàíèÿ äîâîëüíî ÷àñòî âñòðå-÷àþòñÿ ñðåäè êóðèëüùèêîâ. Ïðîéäåòåù¸ 1-9 ìåñÿöåâ è óìåíüøèòñÿ óòîìëÿåìîñòü,à òàê æå êàøåëü, îäûøêà,óâåëè÷èòñÿ ñîïðîòèâëÿåìîñòü îðãàíèçìàèíôåêöèÿì. ×òî æ, íåïëîõî.Îñîáåííî åñëè ó÷åñòü, ÷òî çà ýòîò ãîäÂû ñìîæåòå ñýêîíîìèòü äîïîëüíèòåëüíîîêîëî 659 äîëëàðîâ, ïðèóñëîâèè, åñëè ðàíüøå Âû êóðèëè ïî 1ïà÷êå ñèãàðåò âäåíü. Ìåæäó òåì,èçìåíåíèÿ âî âíóòðåííèõîðãàíàõ âûçâàííûåêóðåíèåìðåãðåññèðóþò íå âîäíî÷àñüå. Íî óæå÷åðåç 5 ëåò âîçìîæíîñòüðàçâèòèÿîñòðîãî èíôàðêòàìèîêàðäà, íàðóøåíèéìîçãîâîãî êðîâîîáðàùåíèÿ òàêàÿæå êàê ó íåêóðÿùèõ, à çàáîëåâàåìîñòüðàêîì ëåãêèõ ñíèæàåòñÿ â äâîå ïîñðàâíåíèþ ñ êóðèëüùèêàìè. ×åðåç 10ëåò ïðåäðàêîâûå êëåòêè áóäóò çàìåùàòüñÿíîðìàëüíûìè, è âîçìîæíîñòüðàçâèòèÿ çëîêà÷åñòâåííûõ íîâîîáðàçîâàíèéðàçëè÷íûõ ëîêàëèçàöèéñíèçèòñÿ äî ÷àñòîòû çàáîëåâàåìîñòèó íåêóðÿùèõ. (3)Íî â òî æå âðåìÿ, îáðàòèòåâíèìàíèå, ñêîëü âûñîê ïðîöåíò ìîëîäåæèñðåäè êóðÿùèõ (42%). Íà íàøâçãëÿä, èìåííî â ýòîé âîçðàñòíîéêàòåãîðèè íåîáõîäèìî ìàêñèìàëüíîøèðîêî ïðîâîäèòü àíòèêóðèòåëüíóþïðîãðàììó. À ýòî, â ñâîþ î÷åðåäü,ïîìîæåò ñíèçèòü ðîñò ïàòîëîãèèáðîíõî-ëåãî÷íîé ñèñòåìû â äàííîìðåãèîíå, êîòîðàÿ â ïîñëåäíèå ãîäûâûøëà íà 4 ìåñòî ñðåäè âñåõ ïðè÷èíñìåðòè íàñåëåíèÿ Êàðåëèè. (4)Ðóêîâîäñòâóÿñü èçëîæåííûìèâûøå ôàêòàìè, ìû ñîâìåñòíî ñ ïðîôåññîðîìÝëëèñîì Ðîëåòòîì, ÊýòðèíÊîáîðí, ñòóäåíòàìè Äàðòìóññêîãîìåäèöèíñêîãî êîëëåäæà è àìåðèêàíñêèìîíêîëîãè÷åñêèì îáùåñòâîìíà÷àëè äîëãîñðî÷íóþ ïðîãðàììó«Êàðåëèÿ ñâîáîäíàÿ îò òàáà÷íîãîäûìà» â íåñêîëüêèõ Ïåòðîçàâîäñêèõøêîëàõ. Òàê æå â Êàðåëèè óæå ïðîâîäÿòñÿçàíÿòèÿ ïî ïðåäóïðåæäåíèþêóðåíèÿ ñðåäè øêîëüíèêîâ â ðàìêàõïðîãðàììû «Îñíîâû áåçîïàñíîéæèçíåäåÿòåëüíîñòè». Íî ýòî íå56Barents Newsletter on Occup Health and Safety 1999;2:54–56


åäèíñòâåííîå íàïðàâëåíèå ïðîåêòà,ìû ñ÷èòàåì î÷åíü âàæíûì äëÿ ðîäèòåëåéçàíèìàòüñÿ ïðîôèëàêòèêîéêóðåíèÿ åù¸ äî ðîæäåíèÿ ðåáåíêà.Ïîýòîìó íà÷àëè ðàáîòó â æåíñêèõêîíñóëüòàöèÿõ, ãîòîâèòñÿ ê âûïóñêóáðîøþðà. Ïðîãðàììà ïîääåðæèâàåòñÿìýðèåé ã.Ïåòðîçàâîäñêà.  äàëüíåéøåìïëàíèðóåòñÿ ðàñøèðåíèåïðîãðàììû, èñïîëüçóÿ âîçìîæíîñòèñèñòåìû Èíòåðíåò äëÿ êîíñóëüòàöèéè ñîñòàâëåíèÿ ëè÷íûõ ïðîãðàìì äëÿòåõ, êòî õî÷åò áðîñèòü êóðèòü.ËÈÒÅÐÀÒÓÐÀ1. Ä.Ð.Ëîóðåíñ, Ï.Í.Áåííåòò.Êëèíè÷åñêàÿ ôàðìàêîëîãèÿ.Ìîñêâà: Ìåäèöèíà,1993.2. Ð. Ïåòî è äð. Óðîâåíü ñìåðòíîñòè âðåçóëüòàòå òàáàêîêóðåíèÿ âðàçâèòûõ ñòðàíàõ. Ëàíöåò1992;3:ò339.3. Äæ.Ì.Ñàìåò. Ïîëîæèòåëüíûåýôôåêòû îòêàçà îò êóðåíèÿ.Êëèíè÷åñêèå ñëó÷àè â òîðàêàëüíîéìåäèöèíå. 1991;4:ò12.4. Í.Â.Äîðøàêîâà. Êà÷åñòâîîêðóæàþùåé ñðåäû è çäîðîâüåíàñåëåíèÿ ðåñïóáëèêè Êàðåëèÿ.ÏåòðÃÓ.1997.INFORMATION:Finnish Institute of Occupational HealthSolveig BorgTopeliuksenkatu 41 a AFIN-00250 Helsinkitel. +358-9-4747 900fax. +358-9-2413 804e-mail: solveig.borg@occuphealth.fiinternet: http://www.occuphealth.fi/e/project/vent2000Barents Newsletter on Occup Health and Safety 1999;2:54–5657


ÏÐÎÔÈËÀÊÒÈÊÀ ÇÐÈÒÅËÜÍÎÃÎÓÒÎÌËÅÍÈß Ó ÆÅÍÙÈÍ,ÂÛÏÎËÍßÞÙÈÕ ÒÐÓÄÎÂÛÅ ÎÏÅÐÀÖÈÈÑ ÂÛÑÎÊÈÌ ÍÀÏÐßÆÅÍÈÅÌ ÇÐÅÍÈßÌàëüêîâà Í.Þ., ÐîññèÿÇðèòåëüíî-íàïðÿæåííûå ðàáîòû(ñ êîìïüþòåðíûìèäèñïëåÿìè è ìèêðîñêîïàìè,ñáîðêà ÷àñîâûõ ìåõàíèçìîâ, èçãîòîâëåíèåþâåëèðíûõ èçäåëèé è ò.ï.)òðåáóþò îò ÷åëîâåêà ïðîÿâëåíèéóñèä÷èâîñòè è àêêóðàòíîñòè, ò.å.êà÷åñòâ, ïðèñóùèõ â áîëüøåé ñòåïåíèæåíùèíàì, ÷òî è îáóñëàâëèâàåòïðåèìóùåñòâåííîå èñïîëüçîâàíèå íàòàêèõ ðàáîòàõ æåíñêîãî òðóäà.Ýêñïåðèìåíòàëüíîå èçó÷åíèåóòîìëÿåìîñòè çðåíèÿ áûëî âûïîëíåíîíà ïðèìåðå äâóõ ãðóïï æåíùèíâ âîçðàñòå 21–43 ãîäà, ðàáîòàþùèõ âóñëîâèÿõ çðèòåëüíî-íàïðÿæåííîãîòðóäà. Ïåðâàÿ ãðóïïà - ýòî ñëóæàùèåáàíêîâ è íàëîãîâûõ èíñïåêöèé, ðàáîòàþùèåñ âèäåîòåðìèíàëàìè, âòîðàÿãðóïïà – ñáîðùèêè ìèêðîñõåì, èñïîëüçóþùèåâ ïðîöåññå ðàáîòû ìèêðîñêîïû.Ïî ãèãèåíè÷åñêèì êðèòåðèÿìîöåíêè óñëîâèé òðóäà ïî ïîêàçàòåëÿìâðåäíîñòè è îïàñíîñòè ôàêòîðîâïðîèçâîäñòâåííîé ñðåäû, òÿæåñòè èíàïðÿæåííîñòè òðóäîâîãî ïðîöåññà[1] òðóä æåíùèí ïåðâîé ãðóïïûîòíîñèòñÿ ê êëàññó 3.2, âòîðîéãðóïïû – ê êëàññó 3.1. êà÷åñòâå èíäèêàòîðíîãî ïðèçíàêàóòîìëÿåìîñòè â õîäå îáñëåäîâàíèÿèñïîëüçîâàëîñü ñâåòîâàÿ÷óâñòâèòåëüíîñòü ïî âðåìåíè òåìíîâîéàäàïòàöèè íà àäàïòîìåòðå òèïàÀÄÌ, ïîñêîëüêó îíà òåñíî ñâÿçàíà ñôóíêöèîíàëüíûì ñîñòîÿíèåì ïàëî÷êîâîãîàïïàðàòà ñåò÷àòîé îáîëî÷êèãëàçà [2]. Ïðè òåñòèðîâàíèèîïðåäåëÿëîñü âðåìÿ, òðåáóþùååñÿèñïûòóåìîé äëÿ ðàçëè÷åíèÿ òåñòîáúåêòàñ ÿðêîñòüþ 0,0056 êä/ì 2 ïîñëåäâóõìèíóòíîé àäàïòàöèè ê ñâåòîâîìóïîòîêó îò âíóòðåííåé ïîâåðõíîñòèñòåíîê ïîëîãî øàðà àäàïòîìåòðà,èìåþùåìó ñòàíäàðòíîå çíà÷åíèåÿðêîñòè 795 êä/ì 2 . ÈññëåäîâàíèåÒàáëèöà 1.Âðåìÿ òåìíîâîé àäàïòàöèè ó èñïûòóåìûõ, â ñåêóíäàõ.Ãðóïïà  ïåðâûé Íà ÷åòâåðòîì Íà âîñüìîì÷àñ ðàáîòû ÷àñó ðàáîòû ÷àñó ðàáîòûÏåðâàÿ 35,6+2,7 51,4+3,2 47,3+3,6Âòîðàÿ 32,1+1,6 46,3+2,4 38,8+1,8Êîíòðîëüíàÿ 26,6+2,6 28,4+3,1 32,3+1,9Òàáëèöà 2.Âðåìÿ òåìíîâîé àäàïòàöèè ó èñïûòóåìûõ ïîñëå ïðîâåäåíèÿëàçåðíîãî êóðñà ñíÿòèÿ çðèòåëüíîãî óòîìëåíèÿ, â ñåêóíäàõ.Ãðóïïà  ïåðâûéÍà ÷åòâåðòîì Íà âîñüìîì÷àñ ðàáîòû ÷àñó ðàáîòû ÷àñó ðàáîòûÏåðâàÿ 33,5+2,6 36,8+1,9 37,1+2,3Âòîðàÿ 29,2+2,3 34,1+2,6 32,9+2,6ïðîâîäèëîñü â ïîíåäåëüíèê, ñðåäó,ïÿòíèöó, â òå÷åíèå ïåðâîãî, ÷åòâåðòîãîè âîñüìîãî ÷àñîâ ðàáîòû.Ðåçóëüòàòû èññëåäîâàíèÿ ïðåäñòàâëåíûâ òàáëèöå 1.Àíàëèç äàííûõ ïîêàçûâàåò, ÷òîó ïðåäñòàâèòåëåé îáñëåäóåìûõ ãðóïïíàáëþäàåòñÿ äîñòîâåðíîå ñíèæåíèåñâåòîâîé ÷óâñòâèòåëüíîñòè â ñðåäèíåñìåíû - íà ÷åòâåðòîì ÷àñó ðàáîòû.Ýòî õîðîøî âèäíî èç ñîïîñòàâëåíèÿäàííûõ ñðåäíåé è ëåâîé êîëîíîêòàáëèöû 1.  êîíöå ðàáî÷åãî äíÿ, íàâîñüìîì ÷àñó ðàáîòû, ñíèæåíèåñâåòîâîé ÷óâñòâèòåëüíîñòè âûðàæåíîìåíåå îò÷åòëèâî.  êîíòðîëüíîéãðóïïå æåíùèí, ðàáîòàâøèõ â îïòèìàëüíîìïî îñâåùåííîñòè ðåæèìå áåçïåðåíàïðÿæåíèÿ çðåíèÿ, ñíèæåíèåñâåòî÷óâñòâèòåëüíîñòè ê êîíöó ñìåíûïðîÿâëåíî ñëàáî è ñðåäíèå çíà-÷åíèÿ òåìíîâîé àäàïòàöèè íà 16-80%íèæå, ÷åì â ãðóïïàõ, ðàáîòàâøèõ ñíàïðÿæåíèåì çðåíèÿ. Î÷åâèäíî, ÷òîðàáîòà ñ íàïðÿæåíèåì çðåíèÿ áûñòðîâûçûâàåò çðèòåëüíîå óòîìëåíèå,òîãäà êàê ïðè îïòèìàëüíîé îñâåùåííîñòèè ðàáîòå áåç íàïðÿæåíèÿçðåíèå ïðàêòè÷åñêè íåóòîìëÿåìîå.Èç ýòîãî ñëåäóåò, ÷òî ïðîñòåéøèìèìåðàìè äëÿ ïðåäîòâðàùåíèÿ çðèòåëüíîãîóòîìëåíèÿ ÿâëÿþòñÿ îðãàíèçàöèÿîïòèìàëüíîãî îñâåùåíèÿðàáî÷èõ ìåñò è ðàöèîíàëüíîå ïëàíèðîâàíèåòðóäîâûõ îïåðàöèé, ïðåäóñìàòðèâàþùàÿ÷åðåäîâàíèå öèêëîâñ íàïðÿæåíèåì çðåíèÿ ñ öèêëàìèîòäûõà èëè âûïîëíåíèÿ ðóòèííûõðàáîò, íå òðåáóþùèõ íàïðÿæåíèÿçðåíèÿ. Ê ñîæàëåíèþ, íà ïðàêòèêåñëåäîâàíèå ýòèì ïðîñòûì ðåêîìåíäàöèÿìíå âñåãäà âîçìîæíî, è òîãäàðàçâèòèå çðèòåëüíîãî óòîìëåíèÿíåìèíóåìî.Äëÿ àêòèâíîãî ñíÿòèÿ çðèòåëüíîãîóòîìëåíèÿ â 1989 ãîäó áûë58Barents Newsletter on Occup Health and Safety 1999;2:58–59


ïðåäëîæåí íîâûé ñïîñîá, îñíîâàííûéíà èñïîëüçîâàíèè âîçäåéñòâèÿ íàçðèòåëüíûå îðãàíû íèçêîèíòåíñèâíîãîðàññåÿííîãî ëàçåðíîãî èçëó-÷åíèÿ êðàñíîé îáëàñòè ñïåêòðà. Ñïîñîáçàêëþ÷àåòñÿ â òîì, ÷òî â ïåðèîäìàêñèìàëüíîãî óòîìëåíèÿ, íà ÷åòâåðòîì÷àñó ðàáîòû, ðàáîòíèêàìïðåäëàãàåòñÿ â òå÷åíèå äâóõ ìèíóòíàáëþäàòü çà äèíàìè÷åñêîé ñâåòîâîéêàðòèíîé, îáðàçóþùåéñÿ â ïîëîìøàðå â ðåçóëüòàòå ìíîãîêðàòíîãîîòðàæåíèÿ ëàçåðíîãî ëó÷à îòåãî çåðêàëüíûõ ñòåíîê. Òàêàÿ ïðîñòàÿè êðàòêîâðåìåííàÿ ïðîöåäóðà ñóùåñòâåííîóâåëè÷èâàåò êðîâîñíàáæåíèåîðãàíîâ çðåíèÿ (â òîì ÷èñëå ñåò÷àòîéîáîëî÷êè è ïèãìåíòíîãî ýïèòåëèÿ) èàêòèâèçèðóåò îáìåííûå ïðîöåññû,÷òî â ñâîþ î÷åðåäü ñïîñîáñòâóåòóëó÷øåíèþ ôóíêöèè çðåíèÿ.Àïðîáàöèÿ ðàçðàáîòàííîãî ñïîñîáàáûëà ïðîâåäåíà íà îáñëåäîâàííûõãðóïïàõ 1 è 2 ñî çðèòåëüíîíàïðÿæåííûìòðóäîì, ðåçóëüòàòûýêñïåðèìåíòà ïðåäñòàâëåíû â òàáëèöå2.Èç òàáëèöû âèäíî, ÷òî 5-äíåâíûé êóðñ ïî ñíÿòèþ çðèòåëüíîãîóòîìëåíèÿ ñòàáèëèçèðîâàë ïîðîãñâåòîâîé ÷óâñòâèòåëüíîñòè â äèíàìèêåðàáî÷åãî äíÿ, ÷òî ïîçâîëèëîïðåäîòâðàòèòü ðàçâèòèå çðèòåëüíîãîóòîìëåíèÿ è ñîõðàíèòü âûñîêóþðàáîòîñïîñîáíîñòü èñïûòóåìûõ íàïðîòÿæåíèè âñåé ñìåíû. Óëó÷øåííîåñîñòîÿíèå çðåíèÿ ñîõðàíÿëîñü ïîñëå5-äíåâíîãî ëàçåðíîãî êóðñà â òå÷åíèå35 ïîñëåäóþùèõ äíåé, ïîñëå ÷åãî âòå÷åíèå 3 ìåñÿöåâ ïðîèñõîäèëî ïîñòåïåííîåâîçâðàùåíèå çðåíèÿ â èñõîäíîåñîñòîÿíèå. Ïîâòîðíûé ëàçåðíûéêóðñ â ýòîò ïåðèîä äàåò òàêèå æåïîçèòèâíûå ðåçóëüòàòû, êàê è ïåðâîíà÷àëüíûé.Òàêèì îáðàçîì, ïðè çðèòåëüíîíàïðÿæåííûõðàáîòàõ äëÿ ñíÿòèÿçðèòåëüíîãî óòîìëåíèÿ è ñîõðàíåíèÿôóíêöèè çðåíèÿ, öåëåñîîáðàçíî, ïîâèäèìîìó,íàðÿäó ñ îáùåïðèíÿòûìèìåðîïðèÿòèÿìè ïî îïòèìèçàöèè óñëîâèéòðóäà ïðèìåíÿòü ëàçåðíóþ ôèçèîòåðàïèþäëÿ àêòèâíîãî ïðåäîòâðàùåíèÿçðèòåëüíîé óòîìëÿåìîñòèè ïîâûøåíèÿ ðàáîòîñïîñîáíîñòèæåíùèí-ðàáîòíèö.Ëèòåðàòóðà1. Ãèãèåíè÷åñêèå êðèòåðèè îöåíêèóñëîâèé òðóäà ïî ïîêàçàòåëÿìâðåäíîñòè, îïàñíîñòè ôàêòîðîâïðîèçâîäñòâåííîé ñðåäû, òÿæåñòè èíàïðÿæåííîñòè òðóäîâîãîïðîöåññà./ Ð2.2013-94. Ì.:Ãîñêîìñàíýïèäíàäçîð,1994, 42ñ.2. Ñïðàâî÷íèê ïî îôòàëüìîëîãèè /Ïîä ðåä. Ý.Ñ.Àâåòèñîâà. Ì.:Ìåäèöèíà, 1978, 376ñ.PUBLICATIONSOrders:Finnish Institute ofOccupational HealthPublication OfficeTopeliuksenkatu 41 a AFIN-00250 HelsinkiFinlandFax: +385 9 477 5071Barents Newsletter on Occup Health and Safety 1999;2:58–5959


Editorial BoardValeri Chashchine, Prof., Kola Research Laboratory of Occupational Health, RussiaGennady Kalabin, Prof., Kola Science Centre, RussiaJuri Lupandin, Prof., Petrozavodsk State University, RussiaAnatoly Tkachev, Prof., Institute of Physiology, Russian Academy of Sciences, Archangelsk, RussiaAnatoly Vinogradov, Ph.D, Secretary General, Kola Science Centre, RussiaTore Sund, Head of Dept. of Environment Technology, Molab as, NorwayIngvar Holmer, Prof., National Institute for Working Life, SwedenRandi Eidsmo Reinertsen, Prof., Sintef Unimed, NorwayJuhani Hassi, Prof., Oulu Regional Institute of Occupational Health, FinlandCollaborative organizationsFinnish Institute of Occupational HealthInstitute of Sanitary-Epidemiologic Research, PetrozavodskInstitute of Physiology, Russian Academy of Sciences, ArchangelskKola Science Centre, Russian Academy of SciencesKola Research Laboratory of Occupational HealthNational Institute of Occupational Health, Oslo, NorwayNational Institute of Working Life, SwedenNorth-West Public Health Centre, St. PetersburgSt. Petersburg Scientific Research Institute of Labour and Occupational DiseasesState University of PetrozavodskSintef Unimed, NorwayTrondheim University, Norway60

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