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Горбая Наталья, профессор, доктор медицинских наук, профессор
Красноярский государственный медицинский университет им. проф. В.Ф. Войно-Ясенецкого, Россия
This article considers methodological approaches to the research of health of the faculty members of Russian higher education institutions, as well as to the medical aid organization for this contingent.
Keywords: instructors of Russian higher education institutions, health, sickness rate, organization of medical aid.
Higher education in Russia, as well as in other countries, is a socially important and priority sphere. Forming of the continuous education during the whole life of a person is the worldwide trend nowadays. Getting professional higher education is the first initial stage, followed by multiple additional educational programs after the initial degree, which are necessary for advanced training, further personal development, which are prerequisites for successful competition on today’s labor market. In this way, a big portion of population is being engaged in the educational process and this starts to have an influence on many social and economic phenomena in society. Such a situation makes it clear that attention should be paid to staff of Russian higher education institutions as the quality of professional training and retraining depends on their successful operation.
According to official data of 2012, there are 1100 higher education institutions in Russia with over 300 thousand instructors. The quality of work of faculty members of higher education institutions depends on many factors, both objective and subjective, internal and external. External (objective) factors include material and technical base of an educational institution, organization of educational process, etc. Internal (subjective) factors are comprised of labor conditions satisfaction, the level of material remuneration satisfaction, mutual relationships in teams, especially with administration, as well as achievement motivation, etc.
The state of health of pedagogical employees has a crucial role among many other factors, influencing the quality of pedagogical labor. Health is both an external and an internal factor, simultaneously. As an external factor, bad health condition leads to frequent cases of temporary incapacity for work, increases the duration of each case; as a result, educational process can suffer significantly, the level of class workload increases for other instructors. As an internal factor, bad health state can lead to emotional disorders, narrowing of the circle of interests, fixation of attention on the problems.
As well as influencing the quality of professional activity, health state of higher education faculty members also defines one more function of education, namely, forming of the care-taking attitude towards health among the students. Education, also higher education, is a subsystem, shaping basic characteristics of the new state of socium, forming cultural, intellectual and human resources to enable the conversion to it. In our opinion, healthcare competence and medical activity are important for any professional group but play a special role for faculty members of higher education institutions as those are the instructors who transfer the knowledge to students. Nowadats, it is the pedagogue, who is the real person, able to preserve the health of children in the course of education. Unfortunately, pedagogical community has been evidently undermining the meaning of the pedagogue health culture in preserving and developing health of the trainees up until now.
Although, according to modern science views, health is significantly defined by the lifestyle of a person, one should not ignore the role of the healthcare system in the process of individual health preservation. Hence, taking into account the above stated arguments, the problem of studying health of faculty members of higher education institutions is urgent, so it the problem of medical aid organization for this contingent. Based on the scientific data derived, it is feasible to develop an optimal model for health preservation of pedagogic staff.
One of the main difficulties in the research of health and medical aid organization for faculty members of Russian higher education institution is the fact that instructors are not distinguished as an independent professional group and are not covered by targeted preventive inspections. It can be connected to the belief that pedagogues face a relatively easy labor, which is not associated with professional harmfulness and thus cannot lead to professional illnesses. However, A.Y. Ryzhov and S.V. Komin, having analyzed physiologic and ergonomic characteristics of lecture and other forms of teaching activity according to the guide Р2.2.755-99, determined that integrated assessment of instructors’ labor leads to a conclusion that it can be presented as an extremely strenuous labor of the 3rd level of the 3rd class of neurotic tension, especially in the intellectual and sensor loads indicators.
E.A. Bagnetova and E.R. Sharifulina assume that the profession of a pedagogue is connected with the risk of such illnesses as dysphonia, nervous disorders (often in the form of asthenoneurotic states), cardiovascular system illnesses (hypertonic manifestations, vegeto-vascular dystonia, stenocardia, etc.), illnesses of upper airways, visual impairments, osteochondrosis, varix dilatation of lower extremities, etc. Intensive load on vocal apparatus lead to the formation of dysphonia and aphonia. Compared to other professional groups, pedagogues are under a high risk of neurotic disorders, accumulation of severe forms of neuroses, psycho-somatic problems. There is an increased risk of professional voice disorders among pedagogues, which is also confirmed by foreign researchers.
We have conducted research on the health condition of the employees of the departmental higher education institutions. In the course of this research, we compared the results of the surveys of respondents, who were faculty members, and employees, not engaged in the teaching process. The methods used to process the data included analytical, sociological (with the use of the specifically developed questionnaire), copying of the data of medical records and reports, statistical with the use of relative and average values, indicators of time series, expert judgments, correlation analysis. The normal distribution test has been done using criteria of Kolgomogorov and Smirnov, as well as Shapiro and Wilc. Statistical significance test of relative ratios differences has been executed with Student’s t-test, as well as nonparametric methods (?2; U of Mann-Whitney). Critical value of the significance level for hypothesis testing is 5% (p<0.05). In order to indicate a relation between the studied phenomena, Pearson’s r correlation coefficient and Spearman’s coefficient (when talking about rank values)
Analysis of the results derived, enabled the faculty members to subjectively evaluate their health condition, as well as made it possible to clarify the views of the higher education institution employees on its defining factors. The majority of respondents (64.0±3.3%) evaluated the health condition of the instructor corps as average (very rare illnesses, usually good general state), 33.0±3.0% considered the level to be below the average (quite frequent illnesses and the feeling of ill health), and only 3.0±1.2% stated it as low (with chronic diseases, permanently bad general state). In our opinion, it is crucial to take into account the latency of the health condition of the higher education instructors and the tendency towards its overstating by the employees, when evaluating their health.
The results of the research indicate that 12.9±2.4% instructors and 20.6±2.9% employees, not engaged in the teaching process, consider their health to be in excellent and very good conditions. This is the first group of health, which means there is lack of reference to medical and preventive treatment facilities during the year of episodic reference with short-term diseases and malaise, usually pseudoinfluenza. Respectively, 56.5±3.3% and 50.0±3.6% consider their health condition to be good, which is the second group: almost healthy individuals and individuals with risk factors. Respectively, 28.5±3.1% and 26.5±3.0% consider their health mediocre, which comprises the third group: individuals with chronic or exacerbated chronic diseases, requiring ambulatory and polyclinic treatment). 2.0±0.9 instructors 2.9±1.2% employees, not engaged in the teaching process, consider their health to be in a bad state, which represents the fourth group: sick individuals, decompensated in their diseases, needing hospitalization. No statistically significant differences were indicated between the subjective health evaluation by higher education employees of the main group and of the comparison group, except the first health group, the portion of which is almost twice as low among instructors (p<0.05).
Almost half respondents of both main and comparison groups stated that they have chronic diseases, however, their portion among instructors (55.1±3.3%) is significantly higher, than among the individuals, not engaged in the teaching process (45.0±3.2%) (p<0.05). Permanent bad general state is suffered by the instructors more often (5.7±1.2% и2.9±1.2%, respectively, p<0.05)
Analysis of the data copied from the lists of clarified diagnoses of ambulatory cards enabled the objective definition of the illnesses structure of the higher education instructors. Pseudoinfluenza is on the first place (30.0±3.9% cases); the second place (25.0±3.7% cases) is held by osteochondrosis with damage of various parts (most frequently – cervical spine and loin). Hyperpiesis of the first and second stages is on the third place (17.8±3.2% cases). There is a relatively high level of the gastrointestinal disturbance among faculty members. For example, erosive gastritis is diagnosed in 15.53.1% cases, peptic ulcer of duodenum in 12.0±2.7% cases, chronic cholecystitis in 3.6±1,5% cases. A high percentage of the set (38.1±4.1%) is comprised of the respiratory apparatus illnesses, including tracheobronchitis – 10.7±2.6%, chronic maxillary sinusitis – 9.5±2.5%, angina – 9.5±2.5%, pharyngitis – 6.0±2.0%, laryngitis – 2.4±1.2%. This can be attributed to the fact that professional activity of a pedagogue is connected with voice workload. Frequent overstress of the vocal chords, for instance, giving lectures in big rooms with no microphone, created a favorable environment for the forming of various ear, nose and throad pathologies. In addition, according to our observations, a part of chronic illnesses of nasopharynx develops because of acute respiratory diseases and anginas, which the instructors do not treat to a full recovery due to the forced need for continuation of the teaching process.
Sociological method, using the above mentioned specially developed questionnaire, made it possible to study the opinions of the faculty members and other employees of the higher education institution regarding health service. The higher education institution, being a departmental military institution, provides its employees with the right to use departmental medical institutions. The survey showed that only 8.3±1.7% respondents are happy with the organization of medical aid in such an institution. Instructors believe that the main disadvantages include long queues for seeing a doctor or getting a procedure (70.8±3.9% respondents), queues for registry (26.4±3.8%), carelessness of medical staff towards the patients (27.8±3.9%). Narrow range of choice of medical services are also stated as a serious problem by 45.8±4.3% of respondents, so is lack of the opportunity for the execution of the whole complex of diagnostic and laboratory examinations (43.1±4.3%). Sometimes these examinations are urgent in the course of diagnostics and that is when some employees have to turn to other medical facilities, often having to pay for that. Only 40.3±4.2% respondents are ready to pay for treatment, and 44.4±4.3% would agree to pay only for some medical services. 15.3±3.1% of respondents strongly object to paid medical aid. 18.0±3.3% of respondents turn down the use of some prescribed medications due to their high prices. One third of respondents (31.9±4.0%) do not fulfill medical prescriptions due to the lack of free time, and every fifth respondent – due to the deficit of material resources.
Using sociological method (using specifically developed questionnaire) when studying health and organization of medical aid for faculty members of higher education institutions is sufficiently informative, it reflects subjective evaluations of health and the levels of medical services provided. The drawback of this method is that it is very labor-intensive as it requires prior preparation of forms, forming of a representative sample, time for filling out the questionnaires and their processing.
Copying of the medical records and reports data gives an opportunity to receive an objective view on initial and general sickness rate of this professional group. However, this method can only be used on condition that most higher education institution instructors get their health service in one, usually departmental, medical institution. In the majority of cases, the employees of higher education institutions get their health service in medioprophilactic institutions domiciliarily, where medical statistics does not single out their separate professional group, so it is almost impossible to create a sample out of the card index.
However, it is crucial to study the health state and its protection among pedagogues. It is especially important to know, which drawbacks in the organization of health service prevent the fulfillment of health potential in this professional group. This problem can be solved using the expert judgments method. The individuals, who could be engaged as experts, include faculty members, involved in administrative work: chairpersons, deans, heads of organization departments of higher education institutions, vice-chancellors, chancellors. The main labor expenditures of this method are carried out during the initial stage, during the composition of the expert judgment card. The volume of the information that one can expect to receive depends on the precision and completeness of the questions, offered to the experts. Expert judgments method makes it possible to decrease both material expenditures on preparation of the big number of questionnaire forms and time expenditure on the research conduct. Expert interviews, when carried out properly, gives an objective picture of both the state of health of pedagogical corps (including taking into account the latency) and crucial problems of health service of this contingent, playing the role of the basis for its optimization.
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