Medical surveillance of workers previously exposed to asbestos

According to current Italian law health surveillance of workers exposed to asbestos in the past must be maintained even after cessation of asbestos exposure (D.Lgs. 277/91). The law, however, makes no reference to timescales or time limits for clinical monitoring, nor to who is responsible. The main aims of health surveillance of individuals formerly exposed to asbestos can be summarized as follows: early diagnosis of the principal diseases associated with asbestos; counselling for workers; work-related disease certification; epidemiological studies. Medical check-ups entail a complete personal and work history, Chest X-Ray, respiratory function tests, TLCO. In all cases the worker must undergo a LDCT. We propose two new possible biological markers for the health surveillance of past-exposed patients: serum mesothelin and osteopontin.     

接触苯乙烯女工的生殖流行病学调查

采用回顾性队列研究的方法，对合成橡胶行业中４６７名生产和使用苯乙烯的女工和５２７名对照工人进行了生殖流行病学调查。结果表明，接触组女工妊娠恶阻及早产、新生儿出生缺陷的危险度增加且具有统计学意义，其他指标未见差异。     

某农药厂氧化乐果作业工人两年健康观察

在1985年和1986年夏季,我们对某农药厂氧化乐果作业工人进行了健康观察,结果发现部分作业工人全血胆碱酯酶(ChE)活性低于0.70。作业组与对照组ChE活性均位经统计学t检验,其差异具有高度显著性。1985、1986年夏季,作业现场氧化乐果空气浓度均位分别为0.732和0.693mg/m~3。结合作业工龄分析,我们认为在氧化乐果平均空气浓度0.7mg/m~3的条件下连续工作1～3个月,可能使作业工人ChE活性受到抑制。     

接触漆酚作业人员突发职业危害的应急健康检查

目的对接触漆酚作业人员进行应急健康检查。方法依据中华人民共和国卫生部令第23号《职业健康监护管理办法》确定检查项目,并依据GBZ20-2002《职业性接触性皮炎诊断标准》做出职业病诊断。结果10例患者诊断为职业性接触性皮炎。结论加强职业卫生监督和宣传机制,切实达到保护劳动者健康的目的。     

Comparative evaluation of 2 epidemiologic surveillance systems of hepatitis A

Epidemiological surveillance represents an important tool for the prevention of hepatitis A. In Italy, the surveillance of hepatitis A is based on the routine notification system of infectious diseases (from 1996 it was replaced by SIMI, Computerised System of Infectious Diseases) and on SEIEVA (Epidemiological Integrated System of Acute Viral Hepatitis). From 1997 to 2000 the two surveillance systems have been compared in Puglia region to evaluate match rate, completeness and sensitivity. A total of 7.018 records from SIMI and 4.413 from SEIEVA have been analyzed. During this period, the 37.0% of cases notified to SIMI match SEIEVA records whereas the 58.8% of cases reported to SEIEVA match cases notified to SIMI. Therefore, the match rate between the two systems was 29.0%. The sensitivity of SIMI and SEIEVA resulted 79.4% and 49.9% respectively. The comparison of the two surveillance systems allowed to recognise problems in local organisation. Therefore, a more adequate training should be supplied to workers involved in the surveillance activities.     

Perspectives on the application of automated systems to epidemiologic surveillance in Cuba

A few considerations on the development of the applied automatization of epidemiologic surveillance systems in Cuba are exposed. Reference is made to aspects of the national strategy, to the lines of development of the National Health Systems, to the projections of the subsystems of epidemiologic surveillance, and to the future integrated intercommunication.     

The use of community-based animal health workers to strengthen disease surveillance systems in Tanzania

An 18 month trial was conducted in three districts of Arusha region, northern Tanzania, to assess the use of community-based animal health workers (CAHWs) in an official disease surveillance system. Disease reports provided by CAHWs were assessed using six indicators for effective disease surveillance, i.e. sensitivity, specificity, timeliness, representativeness, simplicity and acceptability. To assess sustainability issues and determine the incentives required by CAHWs to report disease, three different incentive models were tested in the trial. None of the incentive models involved direct payments to CAHWs. Before involving CAHWs in disease surveillance in the three trial districts, disease case reports as a proportion of cattle population were 0.13%, 0.20% and 0.12%. During the trial, disease case reports as a proportion of cattle population increased to 5.0%, 5.6% and 6.3%. The CAHWs also improved the spatial and temporal coverage of the disease surveillance system and provided timely reports. During the trial, national-level disease reporting in Tanzania increased by 17% owing to the sensitisation and support activities of the Pan African Programme for the Control of Epizootics in Tanzania. In Arusha region, disease reporting increased by 118%, and 49% of this improvement was attributable to increased reporting in the three trial districts. Reporting from these districts far exceeded that from any other district in Tanzania. Veterinarians confirmed the CAHWs' clinical diagnosis in 88% of the 170 clinical cases examined. The increase in disease reporting resulting from CAHW activities was sufficient to enable the national epidemiology unit to achieve its target in relation to World Organisation for Animal Health (OIE) guidelines. The authors conclude that the use of CAHWs should be promoted in the national strategy for disease reporting. Additionally, CAHWs must be brought under the control of the Tanzanian veterinary authorities, a process that will include appropriate legislative reform.     

A hematology surveillance study of petrochemical workers exposed to 1,3 butadiene

Complete blood counts (CBC) have been recognized as an easy and readily available screen for hematotoxicity following occupational exposure to 1,3-butadiene. This study evaluated hematology data from employees who have ever participated in the Shell Butadiene Medical Surveillance Program (BMSP), compared with employees who have not participated. This study examined potential hematopoietic toxicity in relation to the occupational exposures at two Shell facilities. This study included 404 employees who participated in the BMSP, with mean butadiene exposure (TWA-8, TWA-10, and TWA-12 together) of 4.55 ppm from 1979-1996 and 0.25 ppm from 1997-2003, and 773 comparison employees. The comparison group included employees not participating in either the benzene or butadiene surveillance programs. Abnormality of six CBC parameters, including white blood cell count, red blood cell count, lymphocyte count, hemoglobin concentration, mean corpuscular volume and platelet count, and the adjusted mean values of these parameters in the exposed group were compared with those of the comparison group. We found no significantly increased abnormality for any hematology parameter among exposed employees. The adjusted mean values (adjusted for age, sex, race, length of time between first and last exam, current smoking status, and first exam value) of the exposed employees were similar to those in the comparison group. At current occupational exposure levels for 1,3-butadiene, there is no evidence of adverse hematological effects observed in this study. These findings are consistent with results of three similar studies in the literature.     

Protocol for health surveillance of workers exposed to repetitive arm movements

BACKGROUND: Repetitive movements of the upper limbs at work can cause the onset of musculo-skeletal disorders and therefore an adequate planning of health surveillance is needed. A Work Group on this problem was constituted in Brescia, Italy, following the great interest raised by recent scientific meetings on this topic. OBJECTIVES: The aim of the Group was to prepare a proposal for a health surveillance protocol for the use of Occupational Health Physicians. RESULTS: Health surveillance for the prevention of upper limb disorders must be based on the degree of risk. The risk assessment procedure should be based on the methodology currently available for ergonomic analysis and should also consider the frequency of upper limb disorders in the exposed workers. In case of moderate risk, it is necessary to identify hyper-susceptible individuals, in order to reduce exposure to repetitive movements by means of an adequate task fitness evaluation and suitable health education programmes. In situations of medium-to-high risk, a specific programme of health surveillance must be planned in order to identify early disorders and prevent the onset of more severe damage using task fitness evaluation and rehabilitation therapies. The appropriate diagnostic procedure is indicated for this purpose and a classification is proposed to divide the upper limb disorders into two stages, according to the clinical picture: a first acute-subacute stage, which is potentially reversible, and a chronic-subchronic stage, which is non-reversible. Legal reports are required according to the stage of the disease identified and must be supported by an adequate risk assessment.