某冶炼企业作业工人尿砷和血铅检测及临床观察

目的通过检测企业职工的尿砷和血铅含量及对超标者进行临床观察、治疗,了解工作环境中砷、铅对职工身体健康状况的影响。方法采集某冶炼厂一线作业工人的169份尿液和血液,用湿法消解-原子荧光法和石墨炉原子吸收光谱法分别进行尿砷和血铅含量捡测。结果 169名工人中,有25例尿中砷含量增高,45例血中铅含量增高,其中14例尿砷和血铅检测结果同时增高,分别占体检人数的14.79%、26.63%、8.28%。且男性血铅异常百分率明显高于女性(P0.01)。部分砷、铅超标工人出现头昏、腰背酸痛、全身乏力、精神睡眠差、胃肠消化道症状及血、尿常规、肝功异常。结论该企业生产环境中砷、铅已对职工身体健康造成一定影响,应加强作业环境监测,改善劳动条件,提高工人的职业防护意识。     

Neurologic evaluation of workers previously diagnosed with solvent-induced toxic encephalopathy

We examined 52 railroad workers with long-term occupational solvent exposures (average 22 years duration) who had been previously diagnosed by others as having solvent-induced toxic encephalopathy. All described episodes of transient intoxication associated with occupational solvent exposure. Persistent symptoms developed, an average, 16 years after exposure onset and included impaired memory (38), altered mood (21), imbalance (18), and headache (17). Thirteen workers had mild mental status abnormalities, but none fulfilled conventional clinical criteria for encephalopathy or dementia. None had abnormal blink reflex (51) or abnormal electroencephalographic (39) studies. Eight of 47 magnetic resonance imaging studies showed evidence of scattered ischemic lesions among workers with known diabetes mellitus (2), elevated blood pressure (4), or peripheral vascular disease (2). One magnetic resonance imaging scan showed mild cortical atrophy. In stepwise multiple linear and logistic regression models, no statistically significant (P < 0.05) dose-response relationships were found between exposure duration and symptoms or signs that were suggestive of encephalopathy. However, the number of symptoms (P < 0.001) and the number of signs (P = 0.05) were associated with current use of central nervous system-active medications. Further, lower Mini-Mental Status Examination scores were associated with a history of alcohol abuse (P = 0.01) and lower educational level (P = 0.03). The number of chief symptoms involving memory, mood, balance, or headache differed significantly among workers in different geographic sites (F(3.48) = 2.94, P = 0.04), a finding that was not explained by job title or exposure duration. There also was a significant (P = 0.0001) inverse relationship between initial exposure year (r2 = 0.60) or total years of exposure through 1987 (r2 = 0.56) and interval to major neurologic symptom onset, suggesting that factors other than solvent exposure account in part for worker complaints. We found no objective neurologic evidence supportive of toxic encephalopathy or any other uniform syndrome among these individuals, and most complaints were explained by neuropsychological factors or conditions unrelated to occupational solvent exposure.     

Neurological and electroneuromyographic assessment of the adverse effects of acrylamide on occupationally exposed workers

Seventy-one acrylamide workers and fifty-one unexposed referents were studied. Weak legs and numb hands and feet, preceded by skin peeling from the hands, were the early symptoms of the acrylamide workers; their early signs were impairment of vibration sensation in their toes and loss of ankle reflexes. Three cases had cerebellar involvement followed by polyneuropathy due to heavy exposure. Electroneuromyographic changes, including a decrease in the sensory action potential amplitude, neurogenic abnormalities in electromyography, and prolongation of the ankle tendon reflex latency, are of greater importance in the early detection of acrylamide neurotoxicity since they can precede the neuropathic symptoms and signs. The diagnostic criteria for occupational acrylamide intoxication of this study revealed three severe poisonings, six moderate poisonings, and 43 mild poisonings. The total prevalence of acrylamide poisoning was 73.2%. The prevention of dermal exposure to acrylamide should be emphasized.     

An investigation of bias in a study of nuclear shipyard workers

The authors examined discrepant findings between a 1978 proportional mortality study and a 1981 cohort study of workers at the Portsmouth, New Hampshire, Naval Shipyard to determine whether the healthy worker effect, selection bias, or measurement bias could explain why only the proportional mortality study found excess cancer deaths among nuclear workers. Lower mortality from noncancer causes in nuclear workers (the healthy worker effect) partly accounted for the observed elevated cancer proportional mortality. More important, however, was measurement bias which occurred in the proportional mortality study when nuclear workers who had not died of cancer were misclassified as not being nuclear workers based on information from their next of kin, thereby creating a spurious association. Although the proportional mortality study was based on a small sample of all deaths occurring in the cohort, selection bias did not contribute materially to the discrepant results for total cancer deaths. With regard to leukemia, misclassification of occupation in the proportional mortality study and disagreement about cause of death accounted for some of the reported excess deaths.     

Influence of occupational diving upon the nervous system: an epidemiological study

Neurological signs and symptoms were recorded from 156 air and saturation divers and 100 controls. Fifty one (33%) of the divers had had symptoms from the central nervous system during decompression. Also, 22 (14%) had been unconscious while diving. In total 79 (51%) had had decompression sickness (DCS). Twelve (8%) of the divers and no controls had had specific neurological symptoms (vision disturbances, vertigo, reduced skin sensitivity) in non-diving situations, and six (4%) of the divers (no controls) had had episodes of cerebral dysfunction (seizures, transient cerebral ischaemia, transient amnesia). The divers had significantly more general symptoms from the nervous system and more abnormal neurological findings than the controls. The most prominent symptoms were difficulties in concentration and problems with long and short term memory. The most prominent abnormal findings in the divers were compatible with dysfunction in the distal spinal cord or nerve roots, and polyneuropathy. The general neurological symptoms and findings were independently significantly correlated with diving exposure, prevalence of DCS, and age.     

Influence of occupational diving upon the nervous system: an epidemiological study.

Neurological signs and symptoms were recorded from 156 air and saturation divers and 100 controls. Fifty one (33%) of the divers had had symptoms from the central nervous system during decompression. Also, 22 (14%) had been unconscious while diving. In total 79 (51%) had had decompression sickness (DCS). Twelve (8%) of the divers and no controls had had specific neurological symptoms (vision disturbances, vertigo, reduced skin sensitivity) in non-diving situations, and six (4%) of the divers (no controls) had had episodes of cerebral dysfunction (seizures, transient cerebral ischaemia, transient amnesia). The divers had significantly more general symptoms from the nervous system and more abnormal neurological findings than the controls. The most prominent symptoms were difficulties in concentration and problems with long and short term memory. The most prominent abnormal findings in the divers were compatible with dysfunction in the distal spinal cord or nerve roots, and polyneuropathy. The general neurological symptoms and findings were independently significantly correlated with diving exposure, prevalence of DCS, and age.     

Upper limb dynamic responses to impulsive forces for selected assembly workers

This study evaluated the upper limb, dynamic, mechanical response parameters for 14 male assembly workers recruited from selected jobs based on power tool use. It was hypothesized that the type of power tool operation would affect stiffness, effective mass, and damping of the upper extremity; and workers with symptoms and positive physical examination findings would have different mechanical responses than asymptomatic workers without physical examination findings. Participants included operators who regularly used torque reaction power hand tools, such as nutrunners and screwdrivers, and nontorque reaction power hand tools, such as riveters. The mechanical parameters of the upper limb were characterized from the loading response of an apparatus having known dynamic properties while worker grasps an oscillating handle in free vibration. In addition, all workers underwent a physical examination, magnetic resonance imaging, and completed a symptom survey. Workers were categorized as controls or cases based on reported forearm symptoms and physical exam findings. A total of seven workers were categorized as cases and had less average mechanical stiffness (46%, p > 0.01), damping (74%, p > 0.01), and effective mass (59%, p > 0.05) than the seven workers categorized as controls. Magnetic resonance imaging (MRI) findings suggestive of muscle edema were observed for two workers classified as cases and who regularly used torque reaction power tools. No MRI enhancement was observed in the seven subjects who did not regularly use torque reaction power tools. The ergonomic consequences of less stiffness, effective mass, and damping in symptomatic workers may include reduced capacity to react against rapidly building torque reaction forces encountered when operating power hand tools.     

Occupational exposure to polychlorinated biphenyls in electrical workers. II. Health effects.

Health conditions were evaluated in 80 electrical workers exposed for many years to polychlorinated biphenyl (PCB) mixtures with a 42% mean chlorine content, who had blood PCB concentrations from 41 to 1319 micrograms/kg. The clinical study was based on personal history data, physical examination, and laboratory tests (red cell and leukocyte count; determination of haemoglobin, packed cell volume, bilirubin, serum protein electrophoretic fractions, pseudocholinesterase, AST, ALT, GGT, and OCT). Fifteen workers were found to have skin diseases--chloracne (4), folliculitis (4), oil dermatitis (1), juvenile acne (1), and dermatitis due to irritative or allergic agents (5). Sixteen workers showed more or less pronounced hepatic involvement, consisting most often of hepatomegaly with an increase in serum GGT, AST, ALT, and OCT values. In two workers bleeding cavernous haemangiomas were discovered, in one case associated with chronic myelocytic leukaemia. All the workers with chloracne were employed on electric capacitor impregnation with PCBs, and no definite association was found between chloracne and blood PCB concentrations. Conversely, a significant positive association was found between the abnormal liver findings and blood PCB concentrations, particularly trichlorobiphenyl blood concentrations. The abnormal hepatic findings observed are similar to those reported in experimental animals given PCBs, and in some workers such findings should probably be considered as clinical signs of hepatic microsomal enzyme induction.     

Occupational exposure to polychlorinated biphenyls in electrical workers. II. Health effects

Health conditions were evaluated in 80 electrical workers exposed for many years to polychlorinated biphenyl (PCB) mixtures with a 42% mean chlorine content, who had blood PCB concentrations from 41 to 1319 micrograms/kg. The clinical study was based on personal history data, physical examination, and laboratory tests (red cell and leukocyte count; determination of haemoglobin, packed cell volume, bilirubin, serum protein electrophoretic fractions, pseudocholinesterase, AST, ALT, GGT, and OCT). Fifteen workers were found to have skin diseases--chloracne (4), folliculitis (4), oil dermatitis (1), juvenile acne (1), and dermatitis due to irritative or allergic agents (5). Sixteen workers showed more or less pronounced hepatic involvement, consisting most often of hepatomegaly with an increase in serum GGT, AST, ALT, and OCT values. In two workers bleeding cavernous haemangiomas were discovered, in one case associated with chronic myelocytic leukaemia. All the workers with chloracne were employed on electric capacitor impregnation with PCBs, and no definite association was found between chloracne and blood PCB concentrations. Conversely, a significant positive association was found between the abnormal liver findings and blood PCB concentrations, particularly trichlorobiphenyl blood concentrations. The abnormal hepatic findings observed are similar to those reported in experimental animals given PCBs, and in some workers such findings should probably be considered as clinical signs of hepatic microsomal enzyme induction.     

Chronic symptoms in construction workers treated for musculoskeletal injuries.

BACKGROUND: Soft tissue musculoskeletal injuries make up a high proportion of all work-related injuries in construction. Data from Workers' Compensation claims indicate that strains and sprains are the leading compensable injury for construction workers. This study describes the consequences of soft tissue musculoskeletal injuries for construction workers, and assesses the persistence of symptoms after an injury and the impact of that injury on return to work. METHODS: Through an Emergency Department surveillance system [Hunting et al., 1994a], we recorded 176 construction worker visits, from 5/01/93 through 2/28/95, for strains, sprains, joint injury or pain, tendinitis, dislocations, hernias, or other musculoskeletal injuries excluding fractures. Telephone interviews were conducted several months after workers had visited the emergency room for a musculoskeletal injury. RESULTS: Seventy individuals were interviewed about the long-term impacts of 72 incidents that had resulted in work-related musculoskeletal injuries. For 46 (62%) of the 74 diagnoses, problems continued beyond two months. The likelihood of problems continuing more than two months varied considerably by body location of injury. Hispanic workers and older workers were more likely to have continuing symptoms. Eleven of the 45 construction workers with symptoms persisting longer than two months were not employed at the time of the interview. Only 11 of the 45 workers with ongoing symptoms told us that modifications had been made to their jobs to accommodate their symptoms. About one-quarter of these 45 subjects reported substantial effects on home or work life. CONCLUSIONS: Acute musculoskeletal injuries in construction workers frequently result in chronic symptoms, and those with chronic symptoms report substantial effects of the injury on their quality of life. Job accommodations were made in a minority of these injuries. These findings point to the need for heightened efforts for injury prevention in this industry.     

Clinical findings among hard metal workers.

In 1940, the first report appeared describing a pulmonary disorder associated with occupational exposures in the cemented tungsten carbide industry. The disease, known as "hard metal disease," has subsequently been characterised in detail and comprises a wide range of clinical signs and symptoms. In this report, clinical findings in a group of 41 hard metal workers employed until recently are described. A high prevalence of respiratory symptoms was found. Thirteen workers (31%) had abnormal chest radiographs indicative of interstitial lung disease. Fifty per cent of these had been employed in hard metal manufacturing for less than 10 years. Abnormalities of pulmonary function were also frequent and included a restrictive pattern of impairment and decrease in diffusing capacity (27%). Associations were found between diffusing capacity, chest radiographic abnormalities and right ventricular ejection fraction at exercise indicating cardiopulmonary effects. The findings show the continuous need to control excessive occupational exposures to prevent hard metal disease, the history of which now enters its sixth decade.     

Clinical findings among hard metal workers.

In 1940, the first report appeared describing a pulmonary disorder associated with occupational exposures in the cemented tungsten carbide industry. The disease, known as "hard metal disease," has subsequently been characterised in detail and comprises a wide range of clinical signs and symptoms. In this report, clinical findings in a group of 41 hard metal workers employed until recently are described. A high prevalence of respiratory symptoms was found. Thirteen workers (31%) had abnormal chest radiographs indicative of interstitial lung disease. Fifty per cent of these had been employed in hard metal manufacturing for less than 10 years. Abnormalities of pulmonary function were also frequent and included a restrictive pattern of impairment and decrease in diffusing capacity (27%). Associations were found between diffusing capacity, chest radiographic abnormalities and right ventricular ejection fraction at exercise indicating cardiopulmonary effects. The findings show the continuous need to control excessive occupational exposures to prevent hard metal disease, the history of which now enters its sixth decade.     

Pulmonary function and respiratory symptoms in potash workers

Over 94% of the workers in each of four Saskatchewan potash mines participated in a respiratory health surveillance program that included a questionnaire and pulmonary function tests. Compared with a nonexposed control group, potash workers had higher prevalences of cough, dyspnea, and chronic bronchitis but better pulmonary function. Prevalences of symptoms and pulmonary function abnormalities were similar among workers at the four mines tested and at the various job locations. Potash dust, diesel fumes, and other air contaminants may have an irritant effect that leads to the increased prevalences of cough and chronic bronchitis. Although we found no adverse effects of the potash mine environment on pulmonary function, these findings reflect a healthy worker effect or some selection process that makes the potash workers appear healthier in a cross-sectional study.     

Exposure to secondhand smoke at work: a survey of members of the Australian Liquor, Hospitality and Miscellaneous Workers Union

OBJECTIVE: To measure workers' attitudes towards and experiences of exposure to secondhand smoke (SHS) in the workplace. METHOD: A stratified random sample of members from the Victorian Branch of the Australian Liquor, Hospitality and Miscellaneous Workers Union (LHMU) was interviewed by telephone in September 2001. Of the 1,078 respondents surveyed (77% response rate), hospitality workers comprised 49% of the sample, while the remainder comprised community services, property services and manufacturing workers. RESULTS: Overall, 54% of union members were employed in workplaces that did not completely ban smoking and 34% reported being exposed to SHS during their typical working day. Workplaces with total smoking bans had a high level of compliance with these restrictions, with no workers in these settings indicating exposure to SHS at work. Compared with other workers, hospitality workers reported working in environments that had more permissive smoking policies. Consistent with this, 56% of hospitality workers said they were exposed to SHS during a typical day at work compared with 11% of other workers. Overall, 79% of workers expressed concern about exposure to SHS, including 66% of smokers. Compared with other workers, hospitality workers reported a higher level of concern about exposure to SHS at work. CONCLUSION: These findings provide evidence that many workers, and especially those employed in the hospitality sector, are exposed to SHS during their working day and are concerned about the effects of such exposure on their health. IMPLICATIONS: These findings indicate that workplace smoke-free policies are effective in reducing worker exposure to SHS and demonstrate support for the extension of smoke-free policies to hospitality workplaces.     

The role of atopy in potroom workers' asthma

A study was performed to clarify a possible role of atopy in the occurrence of acute bronchoconstrictive impairment observed in some workers in a plant using the Alu-Swiss process for the electrolytic extraction of aluminum. Of 227 workers examined the percentage of those with a history of atopy and positive skin tests for common allergens was within the expected range. Six had positive patch test with 2% NaF. Among seven workers with paroxysmal wheezing and dyspnea, of whom three were only light smokers, three had positive skin test with common allergens but only one of them had an increased IgE value. The same worker also had positive patch test for 2% NaF. The average age of workers with paroxysmal wheezing and dyspnea was 32.6 years, and only two had symptoms defined as chronic bronchitis. Although their forced expiratory volumes, with two exceptions, measured at the beginning of work shift were within normal limits, in most of those workers bronchial hyperreactivity was also objectively assessed using nonspecific bronchoprovocative tests with histamine (or metacholine). The results support our previous findings that acute respiratory impairment in some workers is most probably based on bronchial hyperreactivity and not on an allergic mechanism.     

Detection of Chronic Obstructive Lung Disease

The value of a standard medical history and physical examination in the diagnosis of chronic obstructive lung disease was tested. Nine hundred and ninety-three male patients 40 years old and older were studied at the Mayo Clinic by the use of ventilatory tests and a retrospective review of the medical record for pulmonary symptoms and physical signs. Nearly 20% had abnormal results on at least one test, and about 28% were classified as clinically abnormal according to specified criteria. Ventilatory test results were abnormal in 10% of 714 patients in whom no symptoms, signs, or past history of pulmonary disease was noted. This represents the detection rate for ventilatory abnormality by the use of routine spirometry. Severe degrees of impairment of ventilation may be undetected by the history and physical examination.     

Effects of work and rest on upper extremity signs and symptoms of workers performing repetitive tasks

The temporal relationship between work and signs and symptoms of upper extremity musculoskeletal disorders among workers at risk is relatively unexplored. The study focused on changes in upper extremity circumference, volume, sensory threshold, and reported symptoms after work and rest. All workers (N=50) performed a repetitive poultry processing task and had exhibited upper extremity signs and symptoms in baseline testing prior to this study. These workers manifested significantly increased upper extremity circumference following a period of rest, with circumferences decreasing during work. Upper extremity volume and reported swelling also decreased during work. Reports of tenderness were significantly greater after work than after rest, while reports of pain were greatest after a short rest interval. Results show that the signs and symptoms observed in these workers were manifestations of occupational cumulative trauma and that further study of the relationship between work and signs and symptoms is needed.     

某蓄电池厂2008年在岗工人职业健康检查结果

目的通过铅作业工人在岗期间体检,了解蓄电池厂铅作业工人的职业危害情况。方法收集2008年398名铅作业工人在岗期间体检资料进行分析。结果铅作业工人中有不同程度的神经衰弱症状和消化系统症状。检出职业性慢性铅中毒35人,铅中毒患病率8.8%。结论在岗期间职业健康检查是早期发现健康损害的重要途径,卫生部门应加强监督力度,提高体检率,预防控制铅中毒。     

Acute respiratory symptoms in workers exposed to vanadium-rich fuel-oil ash

BACKGROUND: Occupational exposure to fuel-oil ash, with its high vanadium content, may cause respiratory illness. It is unclear, however, what early acute health effects may occur on the pathway from normal to compromised respiratory function. METHODS: Using a repeated measures design, we studied prospectively 18 boilermakers overhauling an oil-fired boiler and 11 utility worker controls. Subjects completed a respiratory symptom diary five times per day by using a 0-3 scale where 0=symptom not present, 1=mild symptom, 2=moderate symptom, and 3=severe symptom. Daily symptom severity was calculated by using the highest reported score each day for upper and lower respiratory symptoms. Daily symptom frequency was calculated by summing all upper or lower airway symptom reports, then dividing by number of reporting times. Respiratory symptom frequency and severity were analyzed for dose-response relationships with estimated vanadium and PM(10) doses to the lung and upper airway by using robust regression. RESULTS: During the overhaul, 72% of boilermakers reported lower airway symptoms, and 67% reported upper airway symptoms. These percentages were 27 and 36 for controls. Boilermakers had more frequent and more severe upper and lower respiratory symptoms compared to utility workers, and this difference was greatest during interior boiler work. A statistically significant dose-response pattern for frequency and severity of both upper and lower respiratory symptoms was seen with vanadium and PM(10) in the three lower exposure quartiles. However, there was a reversal in the dose-response trend in the highest exposure quartile, reflecting a possible healthy worker effect. CONCLUSIONS: Boilermakers experience more frequent and more severe respiratory symptoms than utility workers. This is most statistically significant during boiler work and is associated with increasing dose estimates of lung and nasal vanadium and PM(10).     

2008～2009年龙岩市某水泥厂职工健康检查结果分析

[目的]了解水泥厂职工的健康状况,为开展职业病防治工作提供依据。[方法]对370名水泥厂职工进行职业性健康检查,并对实验检查结果进行统计分析。[结果]370名受检者中,检出异常195人,异常率为52.70%。肝功异常128例,异常率为34.59%,血脂异常112例,异常率为30.27%。肝功及血脂异常率男女之间、一线工人和后勤工人之间差异有统计学意义（P〈0.05）。[结论]实验室检查结果显示,该厂半数以上的职工正处于亚健康状态或正罹患疾病,因此对职工定期进行健康体检,对疾病的早发现、早诊断及早治疗,保障职工身体健康,避免职业危害,促进安全生产至关重要。