Savushyna I.V. Managing of risk of development of chronic laryngitis in teachers. – Qualifying scientific work on the rights of the manuscript.
Dissertation for the degree of a Candidate of Medical Sciences in specialty 14.02.01 – Hygiene and occupational pathology (222- Medicine). – State Institution «Kundiev Institute of Occupational Health of the National Academy of Medical Sciences of Ukraine”, Kyiv, 2020.
The dissertation is devoted to the study of the influence of conditions and the nature of work on the risk of developing professional laryngitis in teachers of secondary schools depending on the state of health and duration of voice load per week with the development and implementation of an improved algorithm for the treatment of functional disorders of the vocal apparatus in teachers, as well as the development of a modern system of managing the risk of developing professional laryngitis. In the introduction the essence of the scientific problem concerning professional pathology in teachers is disclosed, the main risk factors for the development of general-somatic and occupational diseases are determined the aetiology of diseases of the vocal apparatus in the teachers of secondary schools, is determined the relevance of the topic, is substantiated the methods are determined and outlined the direction of the necessary research, the goal and objectives are formulated, the personal contribution of the applicant is determined, scientific novelty and practical value of the work, testing of the results, structure and volume of the dissertation are given.
Fixed allowable duration of a voice load in teachers. So, with the work experience of 13,5+1,1 years under conditions of influence of vocal load, hypertonus changes presents in the vocal apparatus, and with the work experience – 21,4+0,7 available hypotonus changes. Violation of the voice structure and change of its timbre is noted during the work experience of 13,8+1,1 years.
The risk of development of professional pathology of the vocal apparatus in teachers is calculated. Thus, the probability of illness with work experience of up to 5 years is 0,0006 (5 %), and with the work experience of 35 years and more it is 0,0112 (100 %). At the work experience of more than 20 years, it is sharply increasing the likelihood of getting sick on professional laryngitis (71,7 %). After 20 years of work experience, in conditions of vocal load, the risk of developing a laryngeal disease it matters the age of the teacher, and its etiological particle, due to the causes of the disease, increases from 67,7 % to 81,8 %. Therefore, the age of the teacher 45,8±0,5 and older is critically dangerous for the development of professional laryngitis.
Devoted to the scientific substantiation, development and implementation of a comprehensive system of professional risk management in order to reduce of the morbidity of vocal apparatus from teachers.
The proposed algorithm of professional risk management consists of risk analysis, evaluation of risks, development and implementation measures of risk management and assessment of residual risk. In the case of residual risks the algorithm of actions starts from the beginning.
The analysis of risk includes detection of harmful factors, determining their quantity, and the significance of the risk which they cause. The risk assessment consists of comprehensive and systematic detection of occupational hazards, determination of their level by establishing the quantity of risk. The risk category is defined for the development and implementation of effective measures of risk management. After determining the overall risk, it is necessary to establish a leading factor of risk and select the necessary complex of measures of risk management by filling in the «Risk Management Questionnaire».
Research studies have shown, that increasing the adaptive possibility of teachers to norm reduces the risk of damage of the vocal folds to 45 %. At the same, in teachers with work experience of vocal load up to 20 years by 22 %, and with work experience more than 30 years by 51 %. By reducing the level of stress to the norm, it can reduce the number of cases of impaired circulation in the vocal folds by 50 % and the violation of the tone of vocal folds by 24,8 %.
Individualized preventive measures for risk management, increase the healthy part of life by 7,3 years and reduce the loss of years of healthy life, which is determined by the influence of voice load on 7,1 years. Including for the physical component of health by 4,5 and 4,3 and the psychological health component by 10,3, 10,1 years QALY, respectively.
