Introduction. Рarticipatory medicine. Health, norm. Pre-shift medical examination of workers of nuclear facility as a source of significant individual health indicators. Technological infrastructure for data collection. The digital twin as a tool of participatory. Protection of personal medical data. Conclusion.

Introduction. Digital twin. Digital twin in medicine using the example of Philips. Digital twin as an object of medical information space. Digital twin as an abstraction. Digital twin of worker of nuclear facility at the stage of pre-shift control. Conclusion.

Psychophysiological examination was carried out on two patients, former border guards, who suffered on October 05, 1982 as a result of accidental contact with a source of gamma radiation (137Cs) while on duty while serving on the Iranian-Azerbaijani border in the ranks of the Soviet army. They suffered ARS of the 1st degree with extremely uneven gamma irradiation in the form of local radiation injuries of the hands of varying severity. The assessment of the aver -age dose for the whole body according to the frequency of dicentrics in cultures of peripheral blood lymphocytes in patient No. 1 and patient No. 2 is the same and is 0,26 Gy. Psychophysiological research was carried out in dynamics in 2001-2013 using the automated software and methodological complex «Expert». According to the MMPI data, both victims have a hyperthymic type of psychophysiological adaptation with varying degrees of severity. Patient No. 2 is a chronically hyperthymic personality with a significant increase in the profile on the 9th scale and with its gradual increase in dynamics, which reflects the persistence of hyperthymic personality traits and causes an overstrain of mental adaptation, with an increase in the dynamics of the tendency to explain their difficulties and problems by somatic distress (1Hs). Patient No. 1 has a hyperthymic personality type with a moderate increase in profile dynamics on the ninth scale. A personality trait is indicated by a high, growing in dynamics, indicator on the K scale, which determines behavior depending on social approval and concern for one’s social status. The appearance in dynamics (2013) of a peak on scales 1 (preoccupation with the state of health) and 4 (emotional tension in direct behavior) determines the insufficient ability to internalize the social norm, i.e. insufficient ability to perceive this norm as part of one’s own settings (a combination of profile peaks on scales 4 and 9). The presence of profile peaks on the 7th scale and the scales of the neurotic triad reflect the tendency to various options for the implementation of antisocial attitudes in a socially acceptable way, the desire to appear in a favorable light (scale L). Sufficiently high intelligence and demonstrative behavior determine good adaptation to the environment with self-confidence, high social adaptability, and resilience in overcoming difficulties.

In order to implement the requirements of Federal Law No. 170-FZ of 21.11.1995, Federal Law No. 35-FZ of 08.03.2011, Order of the Ministry of Health of the Russian Federation No. 749n of 28.07.2020, Order of the Ministry of Health of the Russian Federation No. 29n of 28.01.2021, laboratories and psychophysiological examination rooms have been created in medical organizations of the FMBA of Russia. The main purpose of the psychophysiological examination of workers in contact with ionizing radiation sources is to identify persons whose psychophysiological characteristics indicate a low level of functional state of the central nervous system, which causes the risks of developing emergency situations due to the fault of the human factor and is an indication for preventive medical measures within the framework of the program to preserve professional longevity. A promising direction is the widespread introduction of pre-shift psychophysiological examinations of persons whose professional activity is associated with making «critical» decisions. Work is underway at the A.I. Burnazyan Federal State Budgetary Research Center of the FMBA of Russia to create innovative pre-shift control complexes that combine the functionality of medical and psychophysiological examination. The results of this work in the form of hardware and software complexes have already been implemented by a number of organizations using ionizing radiation sources, and at the moment there is an accumulation of information about the results of practical use.

All the centers of occupational pathology of the FMBA of Russia have been established on the basis of multidisciplinary specialized healthcare institutions. The chief freelance professional pathologist annually collects reports on the results of the centers of occupational pathology. According to the data of the Centers of Occupational Pathology of the FMBA of Russia, the profile of the causes of medical contraindications has its own characteristics. The most common causes of medical contraindications include: diseases of the circulatory system, diseases of the eye and its appendage, neoplasms, diseases of the ear and mastoid process, diseases of the blood, hematopoietic organs and individual disorders involving the immune mechanism, which necessitates the implementation of preventive programs in the indicated directions. The main classes of chronic somatic diseases first identified during medical examinations include: diseases of the digestive system, diseases of the endocrine system, eating disorders and metabolic disorders, diseases of the eye and its accessory apparatus, diseases of the circulatory system. In 2022, 8725 examinations of aptitude and connection of the disease with the profession were conducted in the Centers of Occupational Pathology within the established scope of the state task, 514 of them examinations of aptitude for complex cases, 908 examinations of the connection of the disease with the profession.

Профессиональная заболеваемость коронавирусной инфекцией COVID-19 среди медицинских работников учреждений здравоохранения ФМБА России

Relevance. The active development of nuclear and radiation technologies and, as a result, the significant use of ionizing radiation sources in many spheres of life (national economy, science, technology, medicine, etc.) has led to a significant increase in the group of people in contact with ionizing radiation, and, accordingly, to an increase in the risk of abnormal and emergency situations with an increase in the number of victims of radiation. In the clinic of human radiation pathology, local radiation injuries are much more common than other acute radiation injuries. Intention. To determine rates of long-term radiobiological effects in patients with local radiation injuries of varying severity who underwent inpatient treatment in the Clinic of the State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency. Methodology. Rates of the consequences of local radiation lesions of varying severity were assessed based on the medical records of 146 patients who were affected by radiation accidents from 1950 to 2013 and underwent inpatient treatment in the Clinic of the State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency during the aftermath. Results and Discussion. Rates of long-term consequences were assessed depending on severity, location and size of local radiation injuries. Degrees of severity determine typical “clinical portraits” of the radiobiological consequences of local radiation injuries. Conclusion. Information about specific rates of long-term consequences of local radiation injuries can be used by healthcare professionals who care of patients affected by radiation accidents when determining adequate treatment and rehabilitation tactics for maximum preservation of working capacity in the period of consequences.

The main algorithms of actions for the medical personnel of the specialized admission department of the Center for Occupational Pathology at the A.I. Burnazyan Federal Medical and Biological Center of the Federal Medical and Biological Agency when admitting patients injured in radiation accidents and incidents are presented. The authors describe in detail issues of decontamination and priority of medical care, routing of patients within a specialized hospital, problems of sanitary and hygienic safety of personnel.

It is noted that at present the connection between the level of health of the worker and his professional reliability is obvious and does not require additional proof. To prevent radiation accidents caused by the human factor, medical examinations and psychophysiological tests of the personnel of enterprises operating nuclear facilities are carried out. Legislative and normative legal acts regulating the procedure and rules for these medical examinations and inspections are reviewed. The authors present an algorithm for making decisions on the necessity of organizing various types of mandatory medical examinations and psychophysiological examinations of employees of organizations operating nuclear facilities. The experience of specialists of the Federal Medical Biophysical Center named after A.I. Burnazyan of Federal Medical and Biological Agency of Russia shows that up to 25% of the total number of employees who underwent psychophysiological examination have inadmissible deviations (psychophysiological contraindications). This is an indication for rehabilitation measures. After completion of the rehabilitation course repeated examinations are carried out, according to the results of which 92.3% of workers have positive dynamics and return to professional activity.

For persons with occupational diseases who worked at enterprises and organizations served by medical institutions of the FMBA of the Russian Federation, it is relevant to assess their health, taking into account the impact of harmful chemical production factors that have become the causes of their occupational diseases. About 2/3 of cases of occupational diseases caused by chemical hazards are organophosphorus compounds (pesticides), beryllium and its compounds. Of the diseases of non-professional genesis, this group of persons has the highest prevalence of diseases of the circulatory system, musculoskeletal system, digestive and respiratory organs. Of the diseases of the circulatory system, the most commonly diagnosed diseases are those characterized by high blood pressure and coronary heart disease. The structure of diseases of the digestive system is dominated by diseases of the esophagus, stomach and duodenum, diseases of the gall bladder, biliary tract and pancreas. Dorsopathies are the most common within the musculoskeletal disorders; chronic diseases of the upper and lower respiratory tract – within the respiratory diseases.

Ensuring safety of the facilities employing radiation and nuclear hazardous technologies is a priority task for medical organizations serving these facilities. To perform safely at their jobs, it is important for the personnel of nuclear facilities (NF) to have their central nervous systems functioning flawlessly. Certain categories of nuclear industry workers are required to undergo compulsory annual medical examinations (ME) and psychophysiological examinations. This study aimed to develop a concept of psychophysiological examination of NF personnel allowing to assess the central nervous system's functional status. The study involved three groups of nuclear corporation employees (male) counting 720, 364 and 24 people aged from 46 ± 5.3 to 49 ± 6.1 years. The report describes the suggested concept of psychophysiological examination of the specified category of workers, discusses goals, objectives and the procedure of such an examination at all stages of compulsory ME, covers the developed hardware and software sets. The proposed methodological approach is evaluated through consideration of the results of psychophysiological examination of the specified category of workers.

Occupational oncological diseases have a very high social significance. It is necessary to concentrate the eff orts of all interested parties in the development and implementation of effective organizational measures aimed at the timely prevention and diagnosis of malignant neoplasms of professional origin. The purpose of the study is to develop and implement organizational measures at the regional level that will help to diagnose occupational malignant neoplasms in workers whose working conditions are associated with carcinogenic risk.A comparative analysis of the number of detected cases of occupational malignant neoplasms in Russia and European countries is presented. The reasons for the low diagnosis of occupational malignant neoplasms in Russia are identified. A routing scheme for patients with suspected malignant neoplasms of professional origin was developed.The results of the research showed that the proposed organizational form has proved its effectiveness in the diagnosis of occupational malignant neoplasms in workers whose working conditions are associated with carcinogenic risk.Funding. The study had no funding.Conflict of interests. The authors declare no conflict of interest.

The article presents an overview of normative documents and the results of the work of the MEA of the Russian Federation (for 2010-2018) to establish the causal relationship of diseases, disability and death of citizens exposed to radiation factors.

Medical examinations for employees of organizations using sources of ionizing radiation, have a number of features, including the need for a «specialized» medical examination with mandatory psychophysiological examination.

Materials on the work of interdepartmental expert councils for 2011-2014 are presented. The results of the analysis of the conditions and methodological approaches of the establishment by the expert councils of the causal connection of diseases, disability and death of citizens exposed to radiation factors due to the Chernobyl disaster are shown. Data on the number and structure of the taken measures are presented, and the place of the expertise in the system of post-emergency sanitary and hygienic measures is shown.

Economic efficiency of various telemedical services are still a subject of scientific discussion. The article considers approaches to a complex estimation of economic benefit and economic efficiency of services in remote education. Calculations are submitted on the basis of realization of remote trainings series on training to receptions of urgent medical aid and occupational medicine for the medical personnel of the large oil-extracting company. Preparation of the program, materials, including videofragments, presentations and demonstrations, and also realization of trainings were carried out by autsourcing by experts of the foreign organizations.

The lists of the diseases connected with radiation effects existing now at the level not only Russia and Belarus, but also at the Union State in general can be enhanced using cumulative scientific data. There are possible variants, as exceptions in the list of separate nosologies, reasons of which are rather caused not by radiation factors, and as introduction of diseases which radiation nature is confirmed by long-term researches. The conducted researches showed that creation of the single list of diseases within the Union State is a really question solving of which will demand not only significant scientific researches, but also serious legislative initiatives.