"I've been nursing on the railroad....".
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Long-term studies helped to group all railway occupations according to similar occupational and industrial hazards and to morbidity levels. The authors elaborated the main principles of primary prophylaxis for those occupations, considering all the hazards, morbidity levels and economic features.
The paper is concerned with an organizational, structural and functional model of the diagnostic center (DC) in the train, developed by the authors. The DC in the train is a new form of mobile specialized polyclinical aid to the population living in the area of railway stations. The purpose of the model is to draw nearer high-qualified counselling and diagnostic services and prophylactic aid to railway workers. The DC in the train was tried and introduced into western Siberia railway practice. The results of DC in the train establishment are described as is the efficacy of the automated system of early diagnosis of chronic noninfectious diseases, employed under DC conditions.
Loss of hearing due to chronic noise exposition is a well-known pathology and many nations have regulations for the protection of workers with periodical audiometry and ONT check-ups. For the last 15 years, the authors have followed state railway workers of the Milan area who were professionally exposed to noise. All were periodically examined by ONT specialists and submitted to audiometry. The findings underscore the importance of these periodical examinations and their efficacy for the prevention of hearing loss due to noise.
Dust levels and respirable asbestos fibre concentrations were measured at workposts of wiremen and mechanics involved in repairs of railway engines. Measurements and data obtained revealed an excess of allowable concentrations of asbestos fibres in a number of workposts under study. Conclusions and recommendations concerning the work organization and workers' health protection are presented.
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Cardiac response to the physical effort due to occupational work was studied in 33 workers employed in a railway repair shop by means of radioelectrocardiography. The HR ranges, HR mean values and r-ecg changes in different professional groups are described. Attention was paid to the pronounced sinus arrythmia observed in subjects performing hard work. The quantitative and qualitative changes of the obtained results were described and the difficulties in the evaluation of r-e.c.g. records obtained during dynamic examination were emphasized.
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The article stresses that railway hygiene has accumulated vast experience in evaluation of working environment of railway construction workers in severe climate conditions, thorough hygienic characteristics cover the main construction occupations and the exploitation staffers. The research helped to elaborate variety of hygienic regulations on occupational hygiene and work schedules for railway construction workers, on hygienic basis of the workers' everyday life in severe climate conditions.
A historical excursus seems sometimes useful to overlook actual problems in medicine. The example of the railway accidents shows the problems of the medical appraisal with regard to the consequences of an accident. After initiation of a third party insurance in Germany 1871 with reference to the new means of transportation a lot of people tried to get a compensation after imaginary or real injury following a railway accident. Very soon physicians had to give an expert's opinion on the complaints of those concerned. 1879 Rigler and 1918. Horn published monographs regarding this problems. Apart of real impairments very often complaints had no organic reasons. Oppenheim introduced 1889 the concept of "traumatic neurosis". The scientific discussion remained in the following decades and finally it was rejected until to our times. Today the terms "posttraumatic stress disorder", "psychogenic pain disorder" or "adjustment disorder" are valid. The discussions more than 100 years ago seem nowadays still actual. The terms have changed, the problems remain.
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Misdetection of occupational diseases in railway workers is discussed. The reason is that medical staff has poor knowledge of occupational diseases and patients with their signs and symptoms are not all registered. The paper gives scientific rationale for creating a register of occupational diseases in the system of enterprises subordinate to the Ministry of Railways.