铁矿工人尘肺发病及影响因素分析

目的 分析铁矿接尘工人尘肺的发病规律及影响因素,为铁矿工人尘肺防制提供依据.方法 以某铁矿1960年至1974年在册且工作1年以上的所有接尘工人建立队列,随访至2003年底.尘肺诊断由职业病诊断小组确定.采用Cox比例风险模型分析危险因素.结果 队列接尘工人3647名,累积接尘132 574.4人年.诊断尘肺316例,人年发病率为0.24％.1960年前开始接尘者中发现尘肺274例(86.7％),人年发病率为0.40％,明显高于1960年后开始接尘工人尘肺人年发病率(43例,0.07‰).尘肺发病平均潜伏期是(26.0±7.3)年.尘肺晋级年限分别为0+晋Ⅰ期(5.3士3.2)年,Ⅰ晋Ⅱ期为(6.6±5.2)年,Ⅱ晋Ⅲ期为(1 1.3±5.0)年,随诊断年代的推后,各期晋级年限均有延长趋势.164例尘肺为脱尘后诊断,平均脱尘8.3年.铁矿工尘肺发病危险度随累积接尘量增加而上升,呈明显的接触剂量-反应关系.尘肺患者年平均累积接尘量为(173.7±91.6)mg/m3,远高于非尘肺接尘工人(112.1±64.8)mg/m3.除累积接尘量外,影响尘肺发病风险因素包括肺结核(HR=5.9,P＜0.01)、吸烟(HR=1.7,P＜0.01).结论 累积接尘量与尘肺发病之间存在明显的剂量-反应关系,并发结核、吸烟是影响尘肺发病的危险因素.     

大冶铁矿尘肺发病规律及其影响因素

[目的]分析武钢大冶铁矿尘肺发病规律,探讨尘肺发病的主要影响因素。[方法]选择该铁矿1960～1974年间登记在册且工作过1年以上的所有工人建立研究队列,随访至2003年底。收集队列成员的基本资料、职业史、疾病史及各工种历年的粉尘浓度监测资料,分析铁矿尘肺的发病规律。随机选取1714名存活的队列成员,测定TNF-α-308位点及hOGG1Ser326Cys多态性。计算各影响因素对尘肺发病的相对危险度（RR）。[结果]队列共7666人,到2003年底共随访261410.72人年,失访275人。接尘工人3604人,共随访126863.13人年,诊断314例尘肺,尘肺发病率为0.25%,累计发病率8.71%。75.80%的尘肺病例1960年之前开始接尘,83.12%的病例累积接尘量大于50mg（/m^3·a）。铁矿尘肺的平均潜伏期19.65年,77.71%的病例潜伏期在10～30年之间。发病率随着累积接尘量的增加而升高,高、中接尘组相对于低接尘组的RR分别为8.25和2.27;吸烟组尘肺发病率是不吸烟组的1.7倍;肺结核组发生尘肺危险较非肺结核组明显增高（RR=32.34）;TNF-α-308位点及hOGG1Ser326Cys的突变型和野生纯合子组间发病情况差异无统计学意义（P〉0．05）.[结论]累积接尘量高是影响铁矿尘肺发病的根本因素,吸烟和患肺结核可促进其发生。TNF-α-308位点及hOGGISer326Cys多态性在铁矿尘肺的发病中不起主要作用。     

景德镇瓷厂工人死因分析

目的 探索危害陶瓷工人健康的主要疾患及职业有害因素对工人寿命的影响.方法 采用流行病学队列研究方法,对景德镇3个瓷厂1972年到1974年在册且工作一年以上所有陶瓷工人建立队列,随访至2003年底.队列中对死者均查询死因,陶工尘肺由当地疾病控制中心诊断小组确诊,肺癌均收集医院诊断病例.以全国城市居民年龄别死亡率为参照计算标化死亡比(SMR).结果 队列成员共4957名,随访至2003年底,共计130 783.6人年,死亡1636人,死亡率为1250.9/10万,累计死亡率为33.1%.影响陶瓷工人寿命的主要疾病按累计死亡率从高到低排序分别是:恶性肿瘤、心血管疾病、呼吸系统疾病、传染性疾病.与全国平均水平比较,陶瓷工人全死因死亡率基本持平,标化死亡比为1.01,死亡率明显升高的疾病有呼吸系统疾病(SMR=1.30)、陶工尘肺(SMR=36.35)、传染性疾病(SMR=5.08)和肺结核(SMR=4.06).陶瓷粉尘对工人寿命的影响十分明显,接尘工人多种疾病的死亡率均高于非接尘组,除陶工尘肺外,接尘组肺癌(RR=1.9,95%CI:1.2～3.1)、呼吸系统疾病(RR=2.4,95%CI:1.8～3.2)、肺结核(RR=1.6,95%CI:1.2～2.1)明显高于非接尘组,差异有统计学意义.研究还发现全死因、肠癌、肺癌、呼吸系统疾病、肺结核危险度均随接尘严重程度而明显增加,呈现接触一反应关系.结论 陶瓷行业主要职业危害为粉尘,卫生工作重点应是控尘和预防肺结核.     

民用瓷生产粉尘危害预防与陶工尘肺流行病学调查分析

我国民用瓷生产历史长，粉尘危害重。随预防措施逐步实施，陶工尘肺流行病学规律发生了变化。本文对四家有代表性瓷厂的环境、陶工尘肺患病资料分析，原料加工防尘措施日臻完善，陶工尘肺患病率已明显低于成型制坯，１９７０年后接尘人群虽已超过平均发病工龄，但尚未发现陶工尘肺病人。成型制坯１９７５年后接尘人群虽只接近平均发病工龄，但陶工尘肺发病率已达３７８％。建议，今后应对成型制坯粉尘危害重点预防。     

尘肺病例的发病特点分析

目的 探讨尘肺诊断病例的发病特点,为尘肺病防治提供参考依据.方法 对2004至2009年受理的353例尘肺诊断病例的发病情况进行分析,并着重对矽肺、煤工尘肺及陶工尘肺3种尘肺的发病年龄、发病工龄及发病潜伏期进行比较.结果 诊断的353例尘肺包括10种尘肺,其中矽肺(102例)、煤工尘肺(153例)及陶工尘肺(53例)分别占全部尘肺的28.90%、43.34%及15.01%.50年代至80年代开始接尘诊断为尘肺的病例占全部诊断病例的84.99%(300/353).不同年代Ⅰ期矽肺、煤工尘肺及陶工尘肺的发病年龄、发病工龄及发病潜伏期均呈逐渐缩短的趋势.与80年代前比较,80年代以后开始接尘的矽肺和煤工尘肺发病年龄、接尘工龄及发病潜伏期缩短,差异有统计学意义(P＜0.01);80年代后,因北京市的陶瓷业转产,再未见陶工尘肺发病.玉器加工工人矽肺的发病年龄小和发病潜伏期短.结论 矽肺、煤工尘肺发病情况仍不乐观,特别对生产条件较为落后的玉器加工乡镇企业应加强监管.     

煤工尘肺预期发病工龄寿命表法研究

目的 研究煤工尘肺预期发病工龄。方法 收集整理某局1960－1995年期间的8291份接尘工人健康检查资料,分别计算不同时间的尘肺累积发病数,队列寿命表法求得矿工预期发病工龄。结果 煤矿工人的接尘工龄与累积患病率的概率单位之间呈正相关（r=0.98,P=0.0001),煤工尘肺的发病率随工龄的增加而增高,预期发病工龄随工龄的增加而缩短。结论 煤矿工人的尘肺发病工龄约为15年左右,在目前煤矿粉尘浓度水平的条件下,若想把尘肺患病率控制在1％左右,各工种的工人接尘期限以不超过6年为宜。     

某建筑陶瓷厂陶工尘肺流行病学调查分析

[目的]调查建筑陶瓷企业陶工尘肺的发病情况。[方法]对某建筑陶瓷企业1 008例接尘工人(接尘组)进行陶工尘肺流行病学调查,以该企业85例非接尘工人作为对照组。陶工尘肺诊断按现行《尘肺病诊断标准》(GBZ 70-2009)。并对工作场所空气中粉尘浓度进行测定。[结果]陶瓷粉尘总尘浓度0.10~2.95 mg/m3,总尘浓度超标率18.18%,粉尘中游离SiO₂含量43%~44%。在1 008例接尘工人中,诊断为壹期陶工尘肺2例,检出率0.20%。X线胸片表现主要为圆形小阴影q影。接尘组肺通气功能减退和小气道功能异常检出率均明显高于对照组,差异有统计学意义(P<0.05)。接尘组的心电图改变和五官疾病的检出率与对照组相比,差异无统计学意义(P>0.05)。[结论]建筑陶瓷企业的陶工尘肺发病率较低,但其粉尘危害不容忽视,应做好预防控制工作。     

尘肺疾病过程与接尘工人健康监护的关系

目的 分析尘肺流行病学特征，为完善粉尘作业工人健康监护技术规范提供依据。方法 运用回顾性队列研究方法对某地区20个厂矿的尘肺资料进行分析。结果 该地区尘肺的流行病学特征是：（1）尘肺发病平均潜伏期为22．9a。（2）52．2％的尘肺是在脱离接尘后发生的；平均时间为9．1a。（3）尘肺Ⅰ→Ⅱ、Ⅱ→Ⅲ晋期率分别为48．2％和18．5％，晋期平均时间为4．1a和6．8a。（4）尘肺并发结核率为51．3％。（5）尘肺患者平均生存时间为Ⅰ期21．5a，Ⅱ期15．8a，Ⅲ期6．8a，25％的Ⅰ期尘肺患者生存时间超过33a。（6）尘肺患者平均死亡年龄为56．0岁，20世纪90年代中期为66．0岁，已接近同期正常人群寿命。（7）疑似尘肺（0^＋）的潜伏期为20．8a。发展为尘肺的发生率为48．7％。晋为Ⅰ期的平均时间为5．1a。结论 尘肺是一种由于吸人不同生产性粉尘而引起的职业性肺病，呈慢性进展。脱离接尘作业后仍会发病，易并发肺结核，最终影响接尘工人寿命。完善并实施接尘工人健康监护体系是目前我国尘肺防治工作的重点之一。     

锡矿工人接尘与矽肺危险度评价

目的探讨粉尘暴露与矽肺危险度之间的接触效应关系。方法选择广西４个锡矿１９６０～１９６５年间工作１年以上的３０１０名接尘工人进行队列研究。用生存分析法统计累积粉尘接触量和矽肺出现的关系。结果追访到１９９４年底,检出矽肺１０１５例（３３．７％）。矽肺平均潜伏期２１．３年。总粉尘浓度７．５ｍｇ／ｍ３（ＴＷＡ）。拟合生存分析模型表明：矽肺发病危险度与累积接尘量的关系适合Ｗｅｉｂｕｌ分布。累积总粉尘接触量低于１０ｍｇ·ｍ－３·ａ－１时,矽肺危险小于１％;累积总粉尘接触量超过２０ｍｇ·ｍ－３·ａ－１时,矽肺累积危险度升高加快;累积总粉尘接触量达１５０ｍｇ·ｍ－３·ａ－１时,矽肺危险超过６８％。接尘时间与接尘量和矽肺危险度呈正相关。结论矽肺危险度与累积接尘量之间存在接触效应关系。     

疑似尘肺流行病学特征分析

目的分析疑似尘肺(0 )的流行病学特征,探讨其发生发展过程和规律,为疑似尘肺的合理定位提供科学依据。方法将20个厂矿(分为钨矿、锡矿和瓷厂3类)1972年1月1日至1974年12月31日期间在这些厂矿工作至少1年的在册接尘工人作为研究对象,进行回顾性队列研究;随访至1994年12月31日。结果(1)观察对象中有疑似尘肺诊断的病例数为9861例,累积发生率为29.3%;瓷厂的发生率高达32.5%,显著高于其他两个矿(P=0.000)。(2)尘肺病例中有0 记录者占总尘肺病例的60.6%;经0 →Ⅰ期→Ⅱ期→Ⅲ期过程逐步发展的尘肺例数占总尘肺数的56.9%。(3)疑似尘肺的平均潜伏期为(20.8±8.6)年;锡矿最短,仅为(16.9±7.9)年;瓷厂最长,为(24.6±7.7)年。0 潜伏期比Ⅰ期尘肺短约2.1年。(4)观察期内疑似尘肺(0 )进展为Ⅰ期尘肺的发生率为48.7%,显著高于其他非疑似病例接尘者的发病率13.1%(P=0.000)。(5)0 晋升为Ⅰ期尘肺(0 →Ⅰ)的平均时间为5.1年。不同年代0 →Ⅰ的晋期时间不同,差异有统计学意义(P=0.001);随着年代的后移,晋期时间明显延长,其变化规律与Ⅰ→Ⅱ晋期时间变化趋势一致。(5)疑似尘肺生存时间为27.2年,较Ⅰ期尘肺患者长5.2年,差异有统计学意义(P<0.01)。结论疑似尘肺(0 )是工人接尘后早期肺部病理改变的一个重要阶段,是尘肺发生发展的早期过程,易发展为尘肺。应及时制定相关政策,给予疑似尘肺工人适当关怀。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.