原发性肝癌肝动脉节段性化疗栓塞与常规化疗栓塞疗效的对比研究

目的 分析比较乙型肝炎(乙肝)后原发性肝癌治疗中经导管肝动脉节段性化疗栓塞(TASCE)和经导管肝动脉化疗栓塞(TACE)疗效及对肝功能的影响.方法 回顾性选取乙肝后原发性肝癌患者80例,其中行TACE和TASCE治疗各40例,检测其术后1天、术后1周和术后4周血清ALT、AST、TBil和白蛋白(ALB)指标,电子计算机X射线断层扫描技术(CT)检测其术后1月的肿瘤缩小率.结果 ALT分析:TACE组术后1天、术后1周、术后4周分别为(515.25±107.34)、(196.80±64.33)、(65.52±10.20) U/L,高于ASCE组的(117.51±21.47)、(82.13±28.31)、(58.38±8.34) U/L,差异具有显著统计学意义(t=22.98,P＜0.01;t=10.32,P＜0.01;t=3.43,P＜0.01);AST 分析:TACE组术后1天、术后1周、术后4周分别为(454.58±83.09)、(68.72±8.13)和(43.62±6.43) U/L,高于TASCE组的(123.51±19.32)、(48.68±6.57)和(39.54±5.12) U/L,差异具有显著统计学意义(t=24.55,P＜0.01;t=12.13,P＜ 0.01;t=3.14,P＜0.01);TBil分析:TACE组术后1天、术后1周、术后4周分别为(51.97±6.23)、(35.74±4.56)和(20.04±3.81) μmol/L,高于TASCE组的(25.36±3.11)、(23.65±3.21)和(16.75±1.89) μmol/L,差异具有显著统计学意义(t=24.17,P＜0.01;t=13.73,P＜0.01;t=4.89,P＜0.01);ALB分析:TACE组术后1天、术后1周、术后4周分别为(33.54±3.56)、(30.74±3.12)和(32.78±4.11) g/L,低于TASCE组的(37.67±5.34)、(36.95±3.60)和(38.23±3.68) g/L,差异具有显著统计学意义(t=-4.06,P＜0.01;t=-8.24,P＜0.01;t=-6.25,P＜ 0.01).密实型碘油沉积形态肿瘤中,TACE组肿瘤缩小率(50.00％)低于TASCE组(86.36％),差异具有显著统计学意义(x2=5.96,P＜0.05).结论 在乙肝后原发性肝癌治疗中,TASCE方式的疗效和护肝作用明显优于TACE方式.     

子宫动脉栓塞治疗剖宫产瘢痕处妊娠及清宫时机探讨

目的 探讨子宫动脉栓塞治疗剖宫产瘢痕处妊娠(CSP)的临床效果及清宫时机.方法 63例CSP患者清宫术前采用明胶海绵进行子宫动脉栓塞,21例子宫动脉栓塞术后24h内行清宫术(A组),20例1～3d行清宫术(B组),22例4～7d行清宫术(C组).观察清宫术中出血量、血清β人绒毛膜促性腺激素(β-hCG)术后恢复正常时间、住院时间、住院费用及术后并发症.结果 A组和B组住院时间和住院费用分别为(10.5±3.9)、(10.2±5.2)d和(7353±962)、(7594±1032)元,两组比较差异无统计学意义(P＞0.05),但与C组的(13.9±5.4)d、(10 980±1534)元比较差异有统计学意义(P＜0.01).B组和C组清宫术中出血量、血清β-hCG术后恢复正常时间和术后并发症发生率分别为(20.2±8.8)、(20.7±9.3) ml; (25.9±9.3)、(25.7±8.1) d;40.0％(8/20)、40.9％(9/22),两组比较差异无统计学意义(P＞0.05),但与A组的(35.0±10.7) ml、(20.5±7.7)d、66.7％(14/21)比较差异有统计学意义(P＜0.01).结论 采用子宫动脉栓塞联合清宫治疗CSP是一种安全、有效的方法,在子宫动脉栓塞术后1～3 d行清宫术,并发症少,住院时间较短,减少了患者的住院费用.     

血管内皮生长因子在慢性阻塞性肺疾病肺动脉高压痰液中的检测及临床意义

目的 探讨慢性阻塞性肺疾病(COPD)肺动脉高压患者痰液中血管内皮生长因子(VEGF)的变化及临床意义.方法 采用酶联免疫吸附试验(ELISA)方法检测52例稳定期COPD肺动脉高压患者(A组)、60例单纯稳定期COPD患者(B组)以及50例健康查体者(C组)痰液中VEGF水平.并对其肺功能、动脉血气分析及肺动脉收缩压(PASP)进行检测.结果 A、B、C三组VEGF水平分别为(4.30±0.93)、(2.64±0.57)、( 1.48±0.32)μg/L,各组之间比较差异有统计学意义(F=31.612,P＜0.01);第1秒用力呼气容积(FEV1)占预计值的百分比(FEV1％)分别为(48.68±10.53)％、(67.56±14.61)％、( 101.60±21.97)％,各组之间比较差异有统计学意义(F=28.983,P＜0.01);PASP分别为(55.02±11.90)、(23.50±5.08)、(16.16±3.49)mm Hg(1 mm Hg =0.133 kPa),各组之间比较差异有统计学意义(F=34.887,P＜0.01);而各组之间动脉血氧分压(PaO2)、动脉血二氧化碳分压( PaCO2)比较差异无统计学意义(F=2.159、3.167,P＞0.05).VEGF水平与FEV1％呈显著负相关(r=-0.562,P＜0.05),VEGF水平与PASP呈显著正相关(r=0.783,P＜0.05),而VEGF水平与PaO2、PaCO2无相关性(r=-0.318、0.275,P＞ 0.05).结论 COPD肺动脉高压患者痰液中存在VEGF的高表达,VEGF水平与肺功能、PASP显著相关,VEGF在COPD肺动脉高压的发病过程中起着重要的作用.     

2010年新疆维吾尔族、哈萨克族及汉族成年人血脂异常的流行特点

目的 分析2010年新疆地区维吾尔族、哈萨克族及汉族成年居民血脂异常的患病现状及分布特点.方法 2010年采用分层整群随机抽样方法,抽取年龄≥18岁的维吾尔族居民3625名,男性1773名,女性1852名,年龄为(42.89±15.95)岁;哈萨克族居民4148名,男性1649名,女性2499名,年龄为(44.14±13.27)岁;汉族居民3733名,男性1563名,女性2170名,年龄(49.66±12.24)岁,共调查了11 506名.进行问卷调查和身体检查,抽取空腹静脉血检测TG、TC、LDL-C和HDL-C.结果 维吾尔族调查对象TG、TC、HDL-C和LDL-C水平分别为(1.31±1.03)、(4.44±1.20)、(1.41±0.62)和(2.44±0.81) mmol/L;哈萨克族分别为(1.24 ±0.99)、(4.55±1.31)、(1.41±0.62)和(2.40±0.87) mmol/L;汉族分别为(1.62±1.34)、(4.60±1.10)、(1.16±0.68)和(2.23±0.93) mmol/L.维吾尔族、哈萨克族及汉族血脂异常患病率分别为:42.4％(1537/3625)、31.6％(1311/4148)、30.2％(1127/3733),标化患病率分别为:42.4％、31.8％、28.2％,维吾尔族血脂异常患病率高于哈萨克族和汉族,差异有统计学意义(x2=179.87,P＜0.01).维吾尔族、哈萨克族和汉族男性血脂异常的标化患病率分别为52.6％、35.4％、33.2％,维吾尔族男性高于哈萨克族和汉族男性,差异有统计学意义(x2=159.19,P＜0.01).汉族、维吾尔族、哈萨克族高TG血症标化患病率分别为:9.3％,9.3％,17.3％,汉族高TG血症患病率高于维吾尔族及哈萨克族(x2=172.55,P＜0.01).哈萨克族的TC异常标化率(6.9％)高于维吾尔族(5.2％),差异有统计学意义(x2=10.20,P＜0.01).维吾尔族、哈萨克族、汉族的低HDL-C血症标化患病率分别为:33.6％,20.8％,11.1％,维吾尔族高于哈萨克族和汉族(x2 =552.82,P＜0.01),哈萨克族高于汉族(x2=138.01,P＜0.01).3个民族间的高LDL-C血症差异均无统计学意义(P＞0.05).结论 新疆地区3个民族血脂异常患病率均高于全国患病率,且存在民族、年龄及性别间差异.     

PV1终末电势对煤工尘肺肺心病并发左心室肥大诊断的意义

目的 探讨心电图PV1终末电势(Ptf-V1)对诊断煤工尘肺肺心病并发左心室肥大的价值.方法 选择煤工尘肺尸检病例中病理诊断为肺心病并发左心室肥大并有测量Pff-V1资料者,按心电图心电轴左偏、无偏和右偏分别选择14例,进行左心室壁厚、右心室壁厚测量,并进行分析.结果 心电轴左偏组、无偏组和右偏组左、右心室壁厚均数比较,差异有统计学意义(F=32.18,P＜0.01;F=8.02,P＜0.01);心电轴左偏组左心室壁厚[(1.81±0.18)cm]明显大于无偏组[(1.47±0.15)cm]和右偏组[(1.39±0.10)cm],差异有统计学意义(P＜0.01),心电轴左偏组右心室壁厚[(0.79±0.14)cm]明显大于无偏组[(0.58±0.14)cm],差异有统计学意义(P＜0.01),心电轴右偏组有心室壁厚[(0.71±0.14)cm]明显大于心电轴无偏组,差异有统计学意义(P＜0.05).心电轴左偏组Ptf-V1检出率(85.71％)明显高于无偏组(35.70％)及右偏组(28.57％),差异有统计学意义(P＜0.01),Ptf-V1绝对值与心电轴左偏组及无偏组左心室壁厚呈正相关(r1=0.92,P＜0.01;r2=0.93,P＜0.05).结论 Pff-V1绝对值增大可作为左心室形态和功能(尤其是左心房负荷增重改变)的判断指标,心电图Ptf-V1结合心电轴左偏对煤工尘肺肺心病患者并发左心室肥大诊断具有一定价值.     

手法复位与手术切开复位内固定治疗肱骨外科颈骨折效果评价

目的 比较手法复位与手术内固定治疗肱骨外科颈骨的效果,为今后临床治疗提供依据.方法 比较两组不同治疗方式的患者治疗后的效果评价、愈合时间及并发症发生情况.结果 手法复位组优良率为95.6％,手术内固定组优良率为93.6％,两组疗效的分布差异有统计学意义(P＜0.05);手法复位组的愈合平均为(44.3±15.7)d;手术内固定组愈合时间平均为(60.7±22.1)d,两组的愈合时间差异有统计学意义(t=5.099,P＜ 0.01);经过治疗后随访,手法复位组并发症发生率为2.9％,手术内固定组并发症发生率为9.0％,两组患者治疗后并发症的发生率差异有统计学意义(x2=13.17,P＜0.01).结论 手法复位组治疗肱骨外科颈骨折的效果优于手术内固定.     

CT血管造影和三维数字减影血管造影在颅内动脉瘤破裂出血诊断中的对比研究

目的 对比研究CT血管造影(CTA)和三维数字减影血管造影(3D-DSA)在颅内动脉瘤破裂出血诊断中的价值.方法 75例经头颅CT诊断为自发性蛛网膜下隙出血(SAH)患者,分别进行CTA和3D-DSA检查.对比CTA与3D-DSA对动脉瘤确诊率及显示瘤颈和载瘤动脉的关系.结果 75例患者中共确诊动脉瘤69例,动脉瘤数目为83个.3D-DSA动脉瘤确诊率为100.0%(83/83),假阴性率为0;CTA动脉瘤确诊率为86.7%(72/83),假阴性率为13.3%(11/83).3D-DSA与CTA对于动脉瘤的确诊率比较,差异有统计学意义(x2=11.78,P＜0.01).3D-DSA与CTA对于动脉瘤颈与载瘤动脉的显示比较,差异有统计学意义(x2=15.11,P＜0.01).结论 对颅内动脉瘤破裂出血的诊断,3D-DSA明显优于CTA,3D-DSA诊断动脉瘤具有金标准的地位,特别是在显露小动脉瘤、瘤颈及载瘤血管的关系方面更有优势.     

喉鳞癌组织中表皮生长因子受体、环氧合酶-2的表达及其临床意义

目的 检测喉鳞癌组织中表皮生长因子受体(EGFR)和环氧合酶-2(COX-2)的表达,探讨其相关的临床意义.方法 收集54例喉鳞癌手术切除组织(喉鳞癌组)及癌旁非癌喉黏膜组织(癌旁对照组).按组织分化程度、颈淋巴结有无转移、临床TNM分期进行分组比较EGFR和COX-2的表达.结果 EGFR在喉鳞癌组的阳性表达率为63.0％( 34/54),高于癌旁对照组的42.6％(23/54) (P＜ 0.05),COX-2在喉鳞癌组的阳性表达率为68.5％(37/54),高于癌旁对照组的35.2％(19/54) (P＜ 0.01).喉鳞癌组中EGFR和COX-2的表达量分别为0.584±0.136和0.561±0.134,而癌旁对照组分别为0.161±0.045和0.114±0.027,两组比较差异有统计学意义(P＜0.01).EGFR和COX-2的表达量在不同组织分化程度、颈淋巴结有无转移、不同临床TNM分期之间比较差异有统计学意义(P＜0.05或＜0.01).相关性分析显示喉鳞癌组织中EGFR与COX-2的表达呈正相关(r=0.602,P＜0.01).结论 EGFR和COX-2在喉鳞癌的发生发展中起一定的作用,在肿瘤良恶性的鉴别诊断、临床分期以及判断预后等方面,具有显著的临床意义.     

哮喘控制测试评分与第1秒用力呼气容积的关系

目的 观察哮喘患者的哮喘控制测试(ACT)评分与第1秒用力呼气容积(FEV1)的相关性.方法 选择门诊确诊为支气管哮喘的患者104例,患者填写ACT表,上午进行肺功能测定,分析FEV1占预计值百分比(FEV1%pred)与ACT评分的相关性.结果 ACT评分＜20分患者与ACT评分≥20分患者FEV1%pred分别为(62.22±15.91)%和(89.85±12.28)%,差异有统计学意义(P＜0.01).FEV1%pred＜60%患者、60%≤FEV1%pred＜80%患者及FEV1%≥80%患者的ACT评分分别为(9.62±3.52)、(15.91±3.12)、(20.59±2.31)分,三者比较差异有统计学意义(F=95.657,P＜0.01).三者间两两比较,P值均＜0.05.ACT评分与FEV1%pred具有良好的相关性(r=0.820,P＜0.01).结论 ACT评分与患者的FEV1具有良好的相关性,可作为肺功能测试的补充,有助于指导哮喘患者的治疗.     

血小板源性生长因子BB与血液透析患者颈动脉粥样硬化的关系

目的 测定血液透析患者血浆血小板源性生长因子BB(PDGF-BB)水平,探讨其在血液透析患者颈动脉粥样硬化发生发展中的意义.方法 选择36例维持性血液透析患者作为试验组及性别、年龄相匹配的20例健康体检者作为健康对照组,采用酶联免疫吸附试验法测定两组血浆PDGF-BB水平,同时应用彩色多普勒超声显像仪检查两组颈动脉内膜-中层厚度(IMT)及所探测到的斑块情况,并进行统计学分析.结果 试验组颈动脉IMT为(1.01 ±0.23) mm,颈动脉粥样硬化阳性率为69.4％ (25/36);健康对照组颈动脉IMT为(0.72 ±0.15) mm,颈动脉粥样硬化阳性率为10.0％(2/20).试验组颈动脉IMT及颈动脉粥样硬化阳性率均显著高于健康对照组,差异有统计学意义(P＜0.01).试验组血浆肌酐、白蛋白、总胆固醇较健康对照组显著增高[(1991.8±228.6)μmol/L比(71.2±15.9)μmol/L、(36.78±3.40)g/L比(41.96±2.07) g/L、(4.97±0.57) mmol/L比(4.48±0.84) mmol/L],差异有统计学意义(P＜0.01或＜0.05).试验组血浆PDGF-BB水平显著高于健康对照组[(93.27±31.58)ng/L比(31.71±15.78) ng/L],差异有统计学意义(P＜0.01).试验组中颈动脉粥样硬化阳性患者年龄、血浆PDGF-BB及三酰甘油水平均高于颈动脉粥样硬化阴性患者[(48.04±9.97)岁比(34.54±10.35)岁、(102.60±32.87) ng/L比(72.06±13.67) ng/L、(1.51±0.59) mmol/L比(1.01 ±0.27) mmol/L],差异有统计学意义(P＜0.01).回归分析显示,年龄(β=0.346,P＜ 0.01)、PDGF-BB(β=0.594,P＜ 0.01)为影响IMT的重要因素.结论 血液透析患者血浆PDGF-BB水平明显增高,其对颈动脉粥样硬化的发生有重要作用.     

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 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.     

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.     

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.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

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.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.