矽肺死亡病例分析

[目的]探讨矽肺发展规律,预测今后若干年矽肺发病趋势。[方法]选取1970-2006年新疆乌鲁木齐铁路局矽肺死亡病例525例进行了回顾性分析,对死亡病例的合并症以及肺功能损伤程度及障碍进行分析,并对结果进行统计学分析。[结果]①矽肺死亡病例最多见并发症为慢性支气管炎急性发作、慢性阻塞性肺气肿,为100%;慢性肺源性心脏病、肺结核、糖尿病、气胸、冠心病等也很常见。②各期矽肺死亡病例中肺功能损害差异有统计学意义,轻度肺功能损害在各期均少,其中Ⅰ期矽肺以中度损伤为主,Ⅱ、Ⅲ期以重度损伤为主。③矽肺死亡病例肺功能障碍Ⅰ期以阻塞型和混合型通气障碍为主,Ⅱ、Ⅲ期以限制型通气障碍和混合型通气障碍为主。[结论]应积极预防、早期发现和及时治疗矽肺并发症。长期接触高浓度的生产性粉尘对肺功能的损害作用明显,而且损害的程度随着病期的进展而加重,因此肺功能的检查对矽肺全面诊断、病情演变的动态观察及劳动能力鉴定等有着重要的参考价值。     

慢阻肺,不可不说的话题

慢性支气管炎、慢性阻塞性肺气肿、慢性肺源性心脏病甚至心力衰竭、呼吸衰竭等医学上通称为慢性阻塞性肺疾患(简称慢阻肺),据世界卫生组织统计报道,慢性支气管炎、肺心病等慢性阻塞性肺疾患已是世界上第四位死亡原因,且呈上升趋势,我国更为严峻,故了解与慢性阻塞性肺疾患相关的知识,对疾病的防治来说很有必要。     

慢性阻塞性肺气肿的护理体会

慢性阻塞性肺气肿是指终末细支气管远端的肺组织弹性下降,容积扩大,含气量增多的一种病理状态。严重的肺气肿可因通气和换气功能障碍导致低氧血症及高碳酸血症,进而发展为肺源性心脏病,最后可导致呼吸衰竭和心力衰竭。阻塞性肺气肿常为慢性支气管炎的并发症,是一种严重影响健康的常见病,多发病。但是及时诊断,及时治疗,可以延缓发生肺动脉高压及肺源性心脏病。现将我院对慢性阻塞性肺气肿患者的护理体会,总结如下。     

尘肺患者并发慢性肺源性心脏病相关因素分析

目的 探讨尘肺并发慢性肺源性心脏病的相关影响因素。方法 对1987-1999年住院的病例进行分析。结果 慢性肺源性心脏病发病与尘肺的期别、年龄、并发肺气肿、支气管哮喘等有关；与接尘工龄，并发肺结核无明显相关。结论 为有效防治慢性肺源性心脏病的发生、发展提供依据。     

62例矽肺患者肺通气功能分析

[目的]探讨矽肺患者肺通气功能的损害情况。[方法]对62例矽肺和70例X射线胸片正常的接尘工人做肺通气测量并进行比较。[结果]各期矽肺的用力肺活量（FVC）、第1秒用力呼气容积（FEV1．0），FEV1.0／FVC百分比，呼气中期流量（FEF25％～75％）、最大通气量（MVV）均低于对照组。Ⅰ、Ⅱ、Ⅲ期矽肺的肺通气功能异常率分别为71．4％、84．6％和100％，高于对照组；矽肺伴有并发症者各项肺功能指标均下降。[结论]Ⅰ期矽肺者肺通气功能损害以阻塞型为主，Ⅱ、Ⅲ期患者肺通气损害以混合型为主。各期矽肺患者肺通气功能损害明显，肺通气功能随矽肺期别的升高而降低。     

矽肺合并慢性阻塞性肺疾病

矽肺合并慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)加重了肺组织结构的破坏,造成肺功能迅速下降。随着疾病的进展,后期易出现肺源性心脏病、呼吸衰竭等严重并发症,增加患者死亡风险。本文从矽肺合并COPD的致病危险因素和临床治疗两个方面进行简要综述。     

龙岩市支前民工矽肺患病情况调查

[目的]了解 1969～1972年龙岩市支援福建前线国防建设农村民工矽肺患病情况,为制定相关的社会救济政策提供依据.[方法]1997年、2007年对2840名支前民工进行矽肺患病及并发症发病情况调查.[结果]调查2840人,检出确立肺患者458例(Ⅰ期376例、Ⅱ期75例、Ⅲ期7例),患者病率为16.13%;矽肺合并肺结核95例,合并率为20.74%(Ⅰ期18.09%、Ⅱ期32.00%、Ⅲ期3/7);矽肺患者肺结核等并发症死亡35例,病死率为5.46%(Ⅰ期3.72%、Ⅱ期13.33%、Ⅲ期1/7).[结论]支前民工矽肺发病率很高.     

矽肺合并慢性肺原性心脏病的护理体会

矽肺是由于长期大量吸入含有游离二氧化硅粉尘的空气而引起的,以肺组织弥漫性纤维性变为主的全身性疾病。晚期病人多合并慢性支气管炎,阻塞性肺气肿,最终导致慢性肺原性心脏病。我院自1990年以来,共收治54例矽肺病人,现将护理体会浅谈如下。1 临床资料 54例病人中,男48例,女6例,年龄52～71岁。Ⅱ期矽肺31例,Ⅲ期矽肺23例,病程最短7年,最长42年。54例病人均合并慢性肺原性心脏病,最终治疗好转出院者49例,死亡5例。2 护理体会2.1 心理护理 矽肺合并慢性肺心病者病程较长,体质虚弱,且反复发作,普遍存在悲观恐惧、焦虑忧郁等心理,缺乏治疗信心。我们关心体贴病人,耐心倾听病人诉说,时刻关注病人情绪变化,同时提高护患交流技巧,充分利用一切机会与病人交流,     

肺通气功能测定在矽肺致残程度鉴定中的作用

目的：以肺通气功能测定，鉴定矽肺患者的致残程度。方法：对310例矽肺患者肺通气功能资料作分析。结果：随着矽肺期别增加肺通气功能指标（VC、FEV1、FEV1／FVC、MVV）明显下降，　RV／TLC％增加，尤以Ⅲ期矽肺组更为明显．通气功能障碍以限制性和气道阻塞性的混合性损害为主。随着矽肺期别增加，通气功能异常率增高，肺气肿发生率增加。结论：肺通气功能可客观地评价矽肺患者劳动能力丧失的程度，在致残程度鉴定中占有重要地位，其中FEV1和RV／TLC％两项指标意义更为突出。     

矽肺患者诱发心、肝、肾损伤的临床观察

[目的]通过对矽肺患者的部分临床生化指标的观察,了解矽肺患者是否诱发心、肝、肾损伤以及心、肝、肾损伤是否与矽肺期别有关。[方法]随机选择2004-2006年在新疆医科大学第五附属医院职业病防治科进行住院治疗的矽肺Ⅰ、Ⅱ、Ⅲ期患者分别为116、34、8例,设为矽肺Ⅰ、Ⅱ、Ⅲ期组;另外选择来本院进行体检的年龄相当,无遗传性、传染性疾病,既往无特殊疾病史的人群30例,作为对照组。分别检测四组中每个个体心肌酶谱、肝功能、肾功能值,对数据进行统计学处理。[结果]在矽肺患者不同期别组及对照组中,心肌酶谱、肝功能、肾功能各指标的差异均无统计学意义（P﹥0.05）。[结论]矽肺患者诱发心、肝、肾损伤不明显,且与矽肺期别无关。     

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.     

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.     

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.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

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.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.