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Sanitary supervision of the organization of therapeutic nutrition at industrial enterprises
Therapeutic and preventive nutrition (LPP) is considered (along with comprehensive measures to eliminate harmful working conditions) as a highly effective health factor. BOB is organized at industrial enterprises in order to prevent the disease, provides for an increase in the protective functions of the body of workers in the link with the predominant effect of harmful production factors (chemical, physical, etc.); achieved by inclusion in the diet corresponding to the biological properties of food products. LPP, built taking into account the pathogenetically acting factor in the conditions of production activity, contributes to an increase in the general resistance of the organism and certain most often affected organs and systems, to improve well-being, to increase working capacity, and to reduce general and occupational morbidity.
The LPP is organized on the basis of the “List of productions, professions and positions, the work of which gives the right to receive free therapeutic and preventive nutrition and norms for the free distribution of vitamin preparations”, “Instruction materials of the USSR Ministry of Health on therapeutic and preventive nutrition” (approved by the decision of the State Committee of the CM USSR on labor and social issues and the Presidium of the All-Union Central Council of Trade Unions of 07. 01. 77, No. 4 / P-1); includes 5 rations. Diet No. 1 - for those working in conditions of ionizing radiation and in the production of radioactive compounds of uranium, thorium, etc. (the diet includes foods rich in lipotropic substances that stimulate the antitoxic function of the liver and fat metabolism in this body). Diet No. 2 - for those working with fluorine compounds, alkali metals, cyanide compounds, formalin and its polymerization products, chlorine, nitrogen oxides, etc. (the preventive orientation of the diet is provided by an increased content of high-grade proteins, polyunsaturated fatty acids, calcium and other biologically active substances, inhibiting the accumulation of harmful chemicals in the body). Specialized diet No. 2a - for those working with chromium and chromium compounds (approved on 05.11.81., No. 311 / P-10);
includes food products and hypersensitizing substances, including those with a high content of phosphatides, lecithin, certain amino acids, pectin, organic acids, magnesium salts, calcium and sulfur. Diet No. 3 - for those working with inorganic compounds of lead (letter of the chief state sanitary doctor of the USSR, No. 1984-79, dated 01.06.79); the diet contains increased protein content (primarily due to dairy and fermented milk products), vegetables, fruits (including juices with pulp), and others. Diet No. 4 - for those working with nitro and amino compounds of benzene, compounds of arsenic, phosphorus, tellurium, and chlorinated hydrocarbons and others (the diet contains foods rich in lipotropic factors of a predominant effect on the functionality of the liver and blood-forming apparatus). Diet No. 5 - for those working with tetraethyl lead, brominated hydrocarbons, carbon disulfide, thiophos (currently other pesticides), inorganic mercury compounds, manganese, barium compounds, etc. (the diet includes foods with a high content of high-grade proteins, polyunsaturated fatty acids, lecithin, vitamins to prevent disorders of the nervous system and liver).
In all diets, the restriction of table salt and fatty foods is recommended; increased intake of vitamins (or the issuance of appropriate complex vitamin preparations) is provided for: ascorbic acid 100-150 mg; in diets No. 2 and 2a - also vitamin A (2 mg), PP (15 mg), and others; in diets No. 4 and 5 - vitamin B | (diet No. 5 is combined with heavy drinking).
Complex vitamin preparations are also given to those working under conditions of high temperature and intense heat radiation (metallurgical industry, baking industry): ascorbic acid - 150 mg, vitamin A - 2 mg, B - 3 mg, Vg - 3 mg, PP - 20 mg
BWP is issued only on the days of the work and, as a rule, before its commencement (hot breakfasts), in some cases, upon mandatory agreement with the MSC (sanitary-epidemiological station), during lunch break or in the form of two meals a day. Persons engaged in caisson jobs receive BOB after completion of work. For more details on the organization of the BOB - see "On Hygienic Control of Therapeutic and Preventive Nutrition of Workers with Harmful Working Conditions" (Information Letter of the Ministry of Health of the RSFSR of 05.04.84, No. 05 RP-Za-1432).
Control over the BOB is carried out by medical personnel of the enterprise. The preparation and delivery of LPP is carried out by industrial enterprises' canteens or special dietary canteens in strict accordance with the approved food standards for diets, daily layout menus and food interchangeability standards (nutrition fortification - according to the instructions under the supervision of medical specialists of MSC). It is necessary to set aside special tables for people receiving BOB, to publish leaflets for BOB, to carry out sanitary-educational work to consolidate the correct attitude of workers to BOB at work and at home (i.e., during the whole working week).
In the sanitary control of the BOB organization, an assessment of the conformity of the applied diet to the type of production is given. harmfulness, the use of the necessary instrumental and laboratory research methods, compliance with the instructions for fortifying dishes and diet; laboratory quality control of the LPP is carried out and (together with the occupational health department) the development of comprehensive measures to eliminate the contact of workers with harmful working conditions. At industrial enterprises with a five-day workweek, the cost of LPP increases by 20%: first of all, due to improved nutrition quality by including in the diet foods rich in high-grade proteins and vitamins (rather than a screen-based increase in caloric intake).
An important element of the BOB is milk and dairy products. Milk (or other biologically equivalent products) is given free of charge to people working in enterprises with harmful working conditions (open radioactive substances; toxic compounds - over 50 groups), in accordance with the rules and medical indications (approved on 01.07.68. No. 186 / P-14; letter of the Chief State Sanitary Doctor of the USSR No. 123-6 / 589-19 dated May 29, 79). Milk is dispensed in canteens and buffets of industrial enterprises and institutions (workshops, sections), special points (arrangement, maintenance, equipment and functioning - in accordance with sanitary rules).
It is recommended that raids be conducted on the organization of BOB for workers in industrial enterprises according to the developed program (coverage of those in need of BOB, compliance with the recommended set of products and menus, quality of prepared food, analysis of the actual receipt of a grocery set by workers; issues of supplying enterprise products and replacing some products with others, etc.) the development of proposals for improving the organization of medical care at industrial enterprises (see also the order of the USSR Ministry of Health “On improving the organization of medical nutrition” in medical institutions »№ 540 from 23.04.85 city).
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Sanitary supervision of the organization of therapeutic nutrition at industrial enterprises
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