Vtek: transcript. medical labor expert commission
Illness and disability are not identical concepts. In diseases that are not accompanied by a pronounced functional disorder, the ability to work is often not impaired or slightly limited. At acute diseases and injuries with a favorable outcome in the short term, as a rule, only temporary disability occurs. Disability - persistent complete or limited loss of ability to work - occurs more often with chronic diseases with progressive...
KEC is the main body, collectively decider examination of work ability in a medical institution. According to the regulations on the examination of disability, CEC is organized in medical institutions (hospitals, outpatient clinics, dispensaries, antenatal clinics and other institutions), higher education clinics medical institutions if they have at least 15 doctors on staff who provide outpatient treatment to patients. The commission includes a chairman - chief...
Taking into account the introduction of new economic relations and health insurance, there is a need to consider and regulate the relationships between such participants in the health care system as the patient - the insured - the insurance institution - the private practitioner - health care authorities - the state. Healthcare how essential component The country's socio-economic system is also undergoing a period of reform. One of the first documents of this period was...
KEC consults patients in relation to whom there are difficulties in resolving expert issues, as well as in conflict, difficult situations regardless of the duration of temporary disability. At the same time, the expert question is not considered narrowly, but with an analysis of the validity of the diagnosis, the correctness of treatment, the need for special treatment, referral for consultation, additional examinations, including in other medical institutions.
As opportunities and challenges expand social insurance And social security the goals and objectives of medical labor examination. All activities in the field of VTE are aimed at achieving the main overall goal of public health - maximum long-term preservation people's health and ability to work, disease prevention, reducing the level of incapacity and disability. Organization of VTE The organization of VTE in our country is based on three principles: ...
In the process of consulting the patient, control is carried out over the validity of issuing and extending a certificate of incapacity for work. In a number of institutions, the CEC is charged with mandatory monitoring of the health status of patients whose duration of temporary disability reaches more than 1 month. This control procedure makes it possible to concentrate the attention of the chairman of the EEC, attending physicians and heads of departments on the examination of disability, forces before presenting the patient to ...
Establishing the fact of temporary disability. Determining the nature of disability - temporary, permanent, complete and partial. Compliance established rules issuance and execution of documents certifying temporary disability. Definition optimal timing disability. Establishing the cause of temporary or permanent disability to determine the amount of benefits, pensions and other types of social security. Rational employment of workers who do not have signs of disability, but are in need due to...
One of the functions of the CEC is the preparation of certain temporary disability documents. Only KEC has the right to issue and extend certificates of incapacity for work in following cases: For special treatment in another city, with the approval of the city health department, for the days missing for vacation for sanatorium treatment; caring for a sick family member for more than 3 days; at temporary transfer …
Determination of labor recommendations for disabled people, allowing them to be used residual ability to work. This important event allows you to maintain the ability of a disabled person to work in work accessible to his condition, which has great biological, moral, material and social significance both for the disabled person and for the state. Study of the causes of morbidity and disability. Fulfilling this task contributes to the development of various medical, preventive and social measures...
Persons who have signs of persistent limitations in their ability to live and work and are in need of social protection, in the following cases: with an obvious unfavorable clinical and work prognosis, regardless of the duration of temporary disability - immediately after its establishment, but no later than 4 months of disability. Objectives of the examination of work ability in medical institutions: with a favorable clinical and labor prognosis...
The task of social structure and adaptation of mentally ill patients to work outside of medical institutions (social readaptation and rehabilitation in the terminology of foreign psychiatrists) for last years delivered in many capitalist countries in connection with excessive growth number of mentally ill patients who are expensive to maintain in hospital. This task is resolved mainly through the charity of public and religious organizations and even through the initiative of patients.
In the USSR, from the first days of the existence of the Soviet system, a broad program of social care for the mentally ill and attracting those who have become disabled to feasible work has been consistently implemented. Organizational structure, ensuring the implementation of these activities, is as follows: medical labor colonies and psychoneurological dispensaries with day hospitals and occupational therapy workshops; giving patients work to take home; professional education and the employment of disabled people in the system of cooperative artels, transferred in 1961 to the local industry system; guardianship and patronage; pension provision disabled people; keeping them in nursing homes and boarding schools.
The legal basis for prescribing the listed types of treatment and rehabilitation measures and social assistance are medical expert opinions on the state of health and ability to work of the sick. At the same time, the recommendations of the examination also serve preventive purposes: those who become ill are promptly released from work that is unbearable for them; the conditions and volume of their work are standardized according to medical indications. Labor becomes healing factor and contributes to the restoration of working capacity and the prevention of disability.
Mentally ill people make up a relatively small part (5 - 6%) of the total population of disabled people. However, the uniqueness of disability in mental illness due to changes in the behavior of such patients, it makes the examination of their ability to work especially difficult and requires the mandatory involvement of psychiatrists.
Examination of temporary disability is carried out by attending physicians and Medical Control Commissions (MCC) in medical institutions. Their responsibilities include issuing a certificate of incapacity for work, changing working conditions, transferring to a more light work without a decrease in earnings, etc.
The examination of persistent incapacity for work (disability) is carried out by Medical Labor Expert Commissions (VTEK), working on the basis of medical institutions with the involvement of the most qualified specialists under the direction of social security authorities. The best form of organizing labor examination of mentally ill patients is specialized psychiatric VTEK, working on the basis of psychoneurological dispensaries or hospitals. Typically, a psychiatric VTEC consists of three doctors: two psychiatrists (one of whom is the chairman) and a therapist. Decisions of general VTECs, which do not include psychiatrists, are submitted for approval to specialized psychiatric VTECs and only after that acquire legal force. The responsibilities of the VTEK include determining the degree of disability (disability group) and the cause of disability. VTEK also give labor recommendations regarding the type and conditions of work, profession for retraining, form of employment and treatment and rehabilitation measures, the type of nursing home indicated for health reasons (general type or specialized for the mentally ill), etc. VTE in a socialist state has become not only a large area medical practice, but also a new source of scientific and clinical knowledge obtained on the basis of generalization of this practice, as a result of which methodological guidelines for VTE were developed in the USSR, which guide all expert institutions.
For an expert opinion on work ability, a nosological and topical diagnosis is not enough; a functional diagnosis is also necessary, reflecting the dynamics of the disease and the patient’s real work capabilities. Functional diagnosis is determined through a comprehensive clinical trial patient in medical institution and, if possible, in its working conditions, using all available laboratory methods (electrophysiological, biochemical, pathophysiological, psychological) and materials social studies(occupational route and its changes at different stages of the disease; characteristics from production; materials from a survey of the patient’s behavior at home). A job recommendation is always given taking into account individual characteristics the patient’s personality, his interests and social and labor attitudes. Basic clinical criteria functional diagnosis and prognosis of working capacity, accepted in labor practice psychiatric examination in addition to the nosological diagnosis, the following: type and stage of the disease; the presence or absence of a mental defect after past illness(during the period of remission, in the residual or post-processual period of the disease). If a defect is present, not only its severity and clinical characteristics are taken into account, but also the remaining personality traits, the patient’s attitude towards illness, work and the possibility of compensation for the manifestations of the defect.
Disability is established only in the presence of a protracted, unfavorably ongoing disease that is not inferior to all known treatment measures, or in the presence of an irreversible mental defect that is revealed after the patient has recovered from the acute or subacute period of the disease. Primary referral to VTEC by medical institutions is considered acceptable if all possible therapeutic measures and within the competence of the VKK preventive measures to keep the patient at work: exemption from night shifts, from additional loads, from traveling, transfer to another job without reducing qualifications and earnings, etc. Extreme caution when referring patients to VTEC and when determining persistent incapacity (disability) is shown by doctors in case of neuroses, reactive psychoses, acute psychoses of infectious and toxic etiology, attacks of cyclothymia and circular psychosis (see articles on specific diseases). These diseases are reversible, non-progressive and do not leave a defect after an attack - are the subject of persistent treatment until recovery. Referral to VTEK is justified only in in rare cases unfavorable course, which must be specifically specified in the VKK message sheet indicating additional pathogenetic factors that determine the failure of therapy and the presence of signs of disability. If this is not the case or not all treatment measures have been applied, VTEC can exercise its right to recommend continuation of treatment and extend the period of temporary disability beyond 4 to 5 months. The same caution in identifying signs of disability and persistence in carrying out treatment and preventive measures before referral to VTEK should be exercised in relation to patients with the initial stages of progressive disease processes: acute encephalitis and traumatic brain injuries, the initial stages hypertension, cerebral atherosclerosis, luetic psychoses, schizophrenia. The same applies to convulsive conditions, which first appeared in elderly people: they cannot be transferred to disability until the etiology of the disease and the effectiveness of treatment are clarified (anticonvulsant therapy, antibiotics, dehydration and specific therapy, surgery, etc.). Psychopathy only in rare cases serves as a reason for referral to VTEC: most of these individuals need the active corrective and tonic influence of a healthy team. The presence of signs of disability in psychopathic individuals is established only in cases of protracted states of decompensation and pathological personality development that are not inferior to therapy (astheno-hypochondriacal, obsessive, hysterical, litigious-paranoid, etc.). In 80-90% of mentally ill people, the disease is progressive in nature and ultimately leads to brain destruction and mental defects. But even in these cases, the degree (group) of disability and social and labor recommendations can sometimes change many times depending on the stage of the process. In protracted subacute stages, ongoing processes are unfavorably, in subacute and late stages course of severe craniocerebral injuries and complicated brain injuries, disability group II, less often I, is established with a recommendation to persistently continue treatment and gradually introduce the disabled person (as the active process subsides) to activating medical and labor measures in inpatient or outpatient setting. In the stages of stable remission in the presence of a residual and post-processual defect, as well as in the sluggish latent course of the disease (outside the period of exacerbation) with a significant decrease in working ability, disability group III is established with a recommendation for active employment. The type and working conditions are determined depending on the nature of the remission, the type and severity of the defect, about which we're talking about in special guidelines on VTE. In case of severe, difficult-to-compensate defects, when there is no critical attitude of the patient towards his condition (for example, initial dementia, apathetic-abulic syndrome, etc.), disability group II is determined with a recommendation to work in a medical regime (colony, nursing home, workshops at dispensary, etc.). Special attention an expert and worker in social assistance and employment are required by patients in the stage of slow subsidence of the process, stabilization of remission, formation of a defect and development compensatory mechanisms. Such patients remain incapable of professional work, disabled people of group II. They are transferred to group III disabled people and sent to work in production conditions only after observation in medical workshops and in everyday life confirms the stable nature of remission and stable compensation of the defect. The same criteria for the type and severity of the defect determine the disability group, the type of social assistance, treatment, rehabilitation and pedagogical measures for oligophrenia, which is not characterized by progression (homes for oligophrenic children; auxiliary schools; boarding schools; occupational therapy workshops; general and special workshops of artels of disabled people; work under supervision at enterprises, state farms, collective farms, etc.).
In the conditions of a socialist state, VTE, as a new area of medical practice, not only studies and determines the state of working capacity of mentally ill people, but also actively influences the increase in their working capacity, promotes compensation of defective conditions and prevention severe forms disability. This preventive value labor examination increases because preventative tips psychiatrists acquire in the decisions of the VKK and VTEC the force of a legal document mandatory for enterprises and institutions. Thus, VTE in the USSR is directly related to the solution of issues of employment and therefore is the basis not only for material support in case of temporary incapacity for work and disability of mentally ill people, but also for all work on the social readaptation of disabled people.
Cancer diseases occupy second place as a cause of disability and mortality, and first place in terms of severity of disability.
The return of a disabled person to active work is the logical conclusion of rehabilitation and provides for his complete self-sufficiency, financial independence and improved quality of life.
To develop an optimal rehabilitation program for a particular patient, it is necessary comprehensive assessment(examination) of his health condition.
For this purpose, a medical labor examination is carried out.
Tasks of medical labor examination
Its task is to determine, through an expert study, the ability to work, to establish the level of decline and duration of its loss due to the disease. At the same time, ability to work is understood as the totality of physical and spiritual capabilities of a person determined by the state of health, which allow him to engage in work.The assessment of working capacity is based on medical (presence of the disease, its complications, clinical prognosis) and social (work prognosis under specific working conditions) criteria.
Thus, the main task of the work ability examination is to determine the possibility this person perform their professional duties depending on medical and social criteria.
In addition, the tasks medical examination work ability includes: developing optimal treatment and regimen to restore or improve health; determining the degree and duration of disability due to disease or other reasons; recommendations for the rational and full use of the labor of persons with limited ability to work without compromising their health; identification of long-term or permanent disability and referral of such patients to a medical and rehabilitation expert commission.
Based on comprehensive data medical examination the presence of a disease in a particular person is established. If changes in health status are temporary (reversible) and recovery is expected in the near future or significant improvement and restoration of the ability to work, then this type of disability is considered temporary.
In addition, disability is divided into complete and partial. Complete disability occurs when a person, due to illness, cannot and should not perform any work and needs a special treatment regimen.
Partial disability refers to the inability to work in one's profession while maintaining the ability to perform other work. If a person can work in easier conditions or perform less work, then he is considered to have partially lost his ability to work.
Documents certifying temporary incapacity for work and confirming temporary release from work (study) are a certificate of incapacity for work (sick leave) and, in some cases, a certificate of established or free form.
Examination of temporary disability is carried out by medical advisory commission (MAC). It is organized in medical institutions if they have at least 15 doctors on their staff. The VKK includes a chairman - chief physician or (in large institutions) his deputy for medical labor examination (MTE), head of the relevant department and attending physician.
If necessary, doctors of other specialties may be invited for consultation. The main areas of work of the medical advisory commission are: constant monitoring of the validity and correctness of issuing documents on temporary disability; resolution of complex and conflicting issues of VTE; decision to extend the period of temporary disability beyond 30 days: establishing the need to transfer the patient to another job, release from work on the night shift; issuance of sick leave for sanatorium-resort treatment and for special treatment in another city; referral of patients to Medical and Rehabilitation Expert Commission (MREC).
With long-term or permanent loss of ability to work (complete or partial), a state of the human body occurs that is defined by the concept of disability. Determining disability is within the competence of the medical rehabilitation expert commission.
Long-term and frequently ill persons who have been continuously in a state of temporary disability for more than 4 months (on sick leave), as well as persons who have received sick leave for the same disease over the past 12 months for a period of more than 5 months with interruptions, are subject to referral to MREC.
In addition, the basis for referring a patient to a medical rehabilitation expert commission is the presence of signs of disability, the end of the period of disability, re-examination, early re-examination.
The main tasks of the MREC in oncology are: determining the state of working capacity, establishing the group of disability and the cause that caused it; determining the timing of the onset of disability for temporarily disabled people; development of work recommendations for disabled people based on health conditions (conditions and nature of work); periodic monitoring of the working capacity of disabled people (re-examination); prevention of disability.
A disability group is established for patients suffering from malignant neoplasms in cases where the resulting dysfunction of the body interferes with the performance of professional duties and has become stable, regardless of the therapy performed.
General criteria for assessing the working capacity of cancer patients
Exist general criteria assessment of the working capacity of cancer patients. They are based on a combination of clinical, general biological and social factors.Among them are taken into account:
1) factors related to the tumor (localization, anatomical type of growth, histological form and degree of differentiation, stage of the process, metastasis, recurrence);
2) factors of the therapy (treatment options, its duration and complications, the volume of surgical interventions, time intervals before and after the start of special treatment);
3) social factors (gender, age, profession, nature and working conditions).
Analysis of all of the above factors allows us to assess the degree of disability of the patient and establish the appropriate disability group.
Group I disability is established for all patients whose health condition is so severe that they cannot Everyday life serve themselves and need outside help. In most cases, these are patients with advanced tumor process, not subject to radical treatment(incurable).
Group I disability is also established for patients who have severe complications as a result of the therapy (amputation of both lower limbs, complete blindness due to the development and/or treatment of a neoplasm, pharyngeal fistulas that make it difficult self-catering and etc.). Disability group I is established for a period of 2 years.
The exception is patients who have malignant tumor detected in an advanced (incurable) form, as well as patients who developed untreatable relapses and metastases after treatment. For these patients, the disability group is established without specifying the period for re-examination.
Group II disability is defined as a patient with complete loss of ability to work, but not in need of outside care. This category includes patients for whom all types of work are contraindicated for a long time due to the possibility of worsening the course of the disease under the influence of labor activity. For example, patients after rectal extirpation, persons with radiation proctitis accompanied by periodic bleeding and severe pain syndrome.
Group II disabilities also include patients with severe chronic diseases, combined defects of the musculoskeletal system, significant loss of vision, for whom work is not contraindicated, but is available only in conditions specially created for them.
An example is patients with severe anatomical defects after hip disarticulation, a short stump of an amputated limb and the impossibility of prosthetics. Disability group II is established for a period of 1 year.
Group III disability is established for patients with reduced ability to work as a result of chronic diseases and anatomical defects. In cases of minor defects or deformations that do not interfere with the performance of normal work, but require some relief or changes in its conditions, there are no grounds for determining a disability group.
Disabled people of group III are mainly persons who need to be transferred for health reasons to work in another profession due to the inability to continue working in their previous occupation, as well as persons with significant limitations in employment opportunities due to severe functional impairments, or who have not previously worked, or who have low qualifications. Appropriate work recommendations are assigned to such patients by decision of the Higher Quality Committee. Disability group Ill is established for a period of 1 year.
The right to receive a pension, its size and various benefits depend in most cases on the causes of disability. Therefore, the medical rehabilitation expert commission, in addition to determining the disability group, establishes its cause.
When considering questions about establishing the cause of disability, MREC makes its conclusion after careful study medical documentation and data confirming the nature of the work, profession, conditions under which the disability developed. Verification of the diagnosis of cancer is mandatory. In the majority of cancer patients, the cause of disability is classified as a “general disease.”
In this case, a general disease is indicated as the cause of disability in cases where the disability occurred either during the period of work, or during training in higher and secondary special education. educational institutions, or after leaving work, but has no connection with the profession.
Disability due to reason general illness gives the right to receive a pension if you have a certain length of service and depending on age. If disability as a result of cancer occurs in childhood or adolescence, then it is defined as disability from childhood or disability before the start of work.
An occupational disease as a cause of disability is established in cases where malignancy occurs as a result of long-term systematic exposure to the body of any carcinogenic factor characteristic of this profession.
The basic principles for determining the ability of patients to work after the end of special treatment are as follows: the majority of patients after radical therapy are recognized as group II disabled within the first year after the end of treatment.
Degree of ability to work
In subsequent years, the degree of working ability is determined taking into account a number of objective factors, which are of paramount importance in the further prognosis of the disease.These include:
1. Age of the patient - important factor in determining ability to work, since it is associated with the characteristics of cancer treatment and various adaptation capabilities of the body in different age groups.
2. The stage of the disease at the time of treatment is one of the decisive factors in determining the disability group. In early forms of cancer (when cure is achieved with an economical program), working capacity is restored in the first months after treatment. With advanced forms of neoplasms, any conditions and types of work are impossible, and patients are recognized as disabled people of group II, and with further progression of the disease - group I.
3. Time elapsed after baking. A long (5-, 10-year) disease-free period after treatment is a favorable factor in assessing ability to work.
4. The nature of the treatment performed. In assessing the ability of patients to work, the types of treatment program, differing in finite chains. It is obvious that palliative care, regardless of its immediate effect, does not allow one to hope for a permanent cure for patients, and in such cases the medical rehabilitation expert commission establishes disability groups.
5. Organ damage by cancer and its location are often very important in the prognosis of the disease. As is known, treatment of cancer of the esophagus, liver, pancreas is still not effective enough and such patients often even in early stages II and even I disability group is established.
The localization of the tumor in the organ itself is essential for determining the labor prognosis. So. for example, when high location cancerous tumor It is possible to perform a sphincter-preserving operation in the rectum, and this is a favorable factor in relation to the labor prognosis.
When the tumor is located in the cardiac part of the stomach, it is often necessary to resort to gastrectomy, which leads to severe disruption of digestive function, whereas with subtotal resections of the stomach such disturbances are rare.
6. Complications caused by use special therapy. It is known that radical surgery It is often a crippling intervention and requires a significant period of time for the body to adapt to new anatomical and physiological conditions.
Therefore, during operations, especially those entailing the inconvenience of being in a group (various stomas), patients are disabled in group II for a longer period of time. When determining the disability group of patients who have undergone chemotherapy and radiation therapy, the presence and duration of myelosuppression are taken into account, radiation complications, and those treated with hormones - the degree of dysfunction of the adrenal glands and other organs.
For a number of nosological forms of neoplasms (systemic diseases, breast cancer, ovarian cancer, etc.), the need for repeated, anti-relapse courses of chemohormonal and radiation treatment, since this will certainly affect the degree of ability to work.
7. Morphological features Tumors are very important in assessing work capacity, as they make it possible to predict the course of the tumor process.
8. Social factors(profession, working and living conditions) can significantly affect ability to work.
So, sometimes, even with relatively favorable neoplasms (skin cancer, lips), patients are forced to change their profession or place of work in order to avoid the harmful effects of ultraviolet radiation, chapping, and minor injuries. On the other hand, in a number of professions (mental and creative work), patients return to work immediately after treatment, without undergoing MREK.
Considering the beneficial effect of the patient’s return to work, it is possible and should be recommended and allowed (if the patient wishes) his return to the team and society with certain disabilities. This should be facilitated by employment, retraining, creation favorable conditions for work (shortened working hours, working at home, etc.).
Thus, the rehabilitation of patients with cancer, the issues of determining their ability to work and employment is a complex set of activities that must be consistently carried out both in the immediate period after completion of treatment and over subsequent years in order to obtain the most favorable results.
Uglyanitsa K.N., Lud N.G., Uglyanitsa N.K.
The tasks facing doctors carrying out work ability examinations require them not only high level training in their specialty and a broad general medical outlook, but also the necessary knowledge in the field of hygiene and occupational physiology, as well as many social issues.
Only under such conditions will it be possible to ensure the timely release of patients from contraindicated work, and subsequently, within the appropriate time frame, their return to work or the establishment of a disability group upon the occurrence of permanent loss of ability to work. Only with a clear, deeply substantiated assessment of the state of the actual working capacity of patients and a qualified expert opinion with its subsequent full implementation is it possible to carry out optimal treatment, preventive and rehabilitation activities, as well as adequate employment of persons with certain types of disabilities.
Our country provides conditions for effective treatment and the fastest readaptation of patients to work, in particular by the fact that the examination of work capacity, carried out by attending physicians and medical advisory commissions (MCC) of medical institutions, as well as medical labor expert commissions (VTEK) of social security bodies, is a single process that has a certain sequence and the necessary focus. This largely creates the prerequisites for the successful implementation of step-by-step rehabilitation of patients and effective monitoring of its results.
Scientific research and long-term observations have shown that properly organized work activity in case of certain chronic diseases outside the stages of exacerbation and significantly pronounced functional disorders does not negatively affect the health of workers, but, on the contrary, contributes to the activation recovery processes in the body and full functioning various organs and systems.
Therefore, when resolving issues of medical labor examination, specialists must proceed from the most important proposition that labor in the conditions of socialist production is a powerful healing and health-improving factor. In particular, satisfaction natural need person in work, positive impact labor for psycho-emotional sphere sick and disabled people is often a decisive condition for the successful implementation of rehabilitation therapy or the prevention of more severe forms of pathology.
At the same time, an extremely important preventive role is played by timely and at the same time, for a sufficiently long period, release from certain contraindicated work or any professional activity of patients in cases where, under the influence of labor processes, it is possible to progress existing functional disorders or develop complications.
Taking into account the difficulties that often arise in diagnosis, determining the clinical and labor prognosis, and thereby the working capacity of patients, medical and labor examination should be accompanied by a detailed comprehensive examination of them with the mandatory use of modern informative methods studying functionality various organs and systems. At the same time, in all necessary cases examination is carried out in a hospital, including, if indicated, in relevant specialized clinical institutions.
A special place is occupied by medical and labor examination of patients with occupational pathology, which is largely due to both the difficulties encountered in carrying out differential diagnosis, assessment of their ability to work and employment, and with the need for the most in-depth study by medical experts of professional production factors and the maximum use of preventive focus in the work of VKK and VTEK.
Due to the current predominance of mild and atypical forms occupational diseases characterized mainly by initial functional disorders, doctors encounter mainly minor disabilities, when for the recovery of patients it is extremely important to timely exclude the impact of etiological professional factor and implementation through the VKK or VTEK of their rational employment.
When organizing the work of people with occupational diseases, significant attention should be paid to finding opportunities to retain their previous qualifications in cases of transfer to another job, or at least to follow the path of such employment when a decrease in production qualifications and wages will be observed to the least extent. For such implementation of the recommendations of the VKK and VTEK on the employment of patients in this category, there are considerable reserves, since their predominantly vaguely expressed functional disorders although they require the exclusion of previous unfavorable production factors, they do not interfere with the choice of non-contraindicated labor.
In modern highly mechanized agricultural production with the widespread use of pesticides and mineral fertilizers, an ever-increasing number of workers who may have contact with certain occupational hazards, the implementation of effective occupational hygiene and safety measures is of particular importance.
Along with the administration and trade union activists of the respective farms in solving these important tasks the role of medical workers, especially doctors, who are faced with issues of assessing work capacity, is great, rehabilitation treatment, health improvement, occupational therapy, organization of work for sick and disabled people, prevention and reduction of disability.
Increasing the efficiency of this work should be facilitated by the constant improvement of forms and methods of medical labor examination.
