职业卫生示范企业创建实践中职业卫生投入分析

目的探讨用人单位职业卫生投入与职业卫生工作水平的关系。方法根据用人单位职业病防治指南及评估工具,通过制度创建职业卫生示范企业的方案和程序文件,企业开展基线评估、针对评估发现的问题采取改进措施、再经专家审议、现场评审与验收等程序,组织企业创建职业卫生示范企业。本研究建立了企业基本情况数据库、示范企业评分结果数据库,并应用SPSS15．0、EpiData3．1软件,使用相关分析方法、一般线性模型等方法进行资料统计与分析。结果参加现场评审的64家企业①人均职业卫生经费排在前三位的行业是核工业、电力和建材,人均费用分别是15953元,8645元,6020元;②职业接触者人均职业卫生费用排在前三位的行业是建材、核工业和电力,人均费用分别是28117元,26469元,25139元;③职业卫生投入占总产值百分比排在前三位的行业是有色、建材和石油,分别是1．45％、1．37％、1．05％;④职业卫生投入占总利税前三位的是化工、有色和航空,分别是38．00％、28．91％、28．76％;⑤职业接触者人均职业卫生费用也与综合得分有线性关系,费用投入高者得分亦高。结论①职业卫生工作水平和职业卫生投入有关,职业接触者人均职业卫生费用是敏感指标,投入越高职业卫生工作水平越高;②开展职业卫生投入、疾病负担的研究,筛查敏感指标,对企业有效分配职业卫生资源具有重要指导意义;③通过研究分析职业卫生政策、措施的成本和效果、筛选优先重点控制领域,对指导国家职业卫生资源的有效合理分配具有重要意义。     

上海市闵行区2009年职业卫生监督量化分级管理现况

目的通过职业卫生监督量化分级管理体系应用,合理配置职业卫生监督资源,提高辖区内企业总体职业卫生管理水平,为其成为长效、持续的职业卫生监督管理模式提供科学依据。方法对2006～2009年职业卫生监督量化分级管理体系应用状况进行分析。结果经资料汇总,2009年职业卫生监督量化分级评分等级结果为:A级企业(≥85分)376家,B级企业(60～84分)829家,C级企业(60分)200家。结论 2006～2009年4年的职业卫生量化分级管理体系应用后,量化分级管理成为我区长效、持续的职业卫生监管模式。     

Occupational health in developing nations: the case of China

The need for a comprehensive view of occupational health problems in developing nations was suggested by a recent occupational health delegation to China. Such problems in most developing nations are superimposed on a background of scarce economic resources, rapid industrialization, and socioeconomic dislocation as well as a poor nutritional and general health status of the population. Occupational health problems are exacerbated in these countries by the presence of a high proportion of very small firms, inadequate attention to industrial hygiene and ergonomic principles for worker health and safety, and a lack of toxicologic and epidemiologic data. The peculiar case of China is noted, wherein only some of the characteristics of a developing nation are exhibited. The Chinese model for occupational health as observed in a spectrum of industries including textiles, paint, and steel is described. Recent political and economic developments are discussed along with their implications for Chinese health policy in general and for occupational health practice in particular.     

河北省某铁矿职业卫生投入产出分析

目的:探讨职业卫生经费投入和产出的关系,为相关部门决策提供依据。方法:于2018年9月,选取河北省某国有铁矿（开采历史10年以上,可代表一般类型的铁矿）为研究对象。通过调查收集企业一般情况、职业卫生投入、损失和产出相关指标,建立铁矿职业卫生经费投入产出表和模型,用matlab软件对经费投入与产出之间的数字关系进行求解。...     

企业职业卫生培训师模式的建立与初期效果评价

目的 探索职业卫生培训的新模式.方法 建立企业职业卫生培训师模式,并选取深圳市宝安区30家企业试运行1 a.结果 27家企业实施“企业职业卫生培训师模式”,一年共培训23 503人次,培训率达96.7％.实施该模式后与实施前比较,职业病防治知识知晓率(x2 =1 431.1,P＜0.01)、个人防护用品自觉佩戴率(x2=1 717.287,P＜0.01)、健康监护档案建档率(x2 =5.909,P＜0.05)、建立危害因素监测及评价制度率(x2 --8.533,P＜0.01)、防护设施完善率(x2=6.857,P＜0.01)等指标均有了明显提高,差异均有统计学意义;企业的整体量化评分均有明显提高.结论 企业职业卫生培训师模式能有效提高职业卫生培训覆盖率,推动企业的职业病防控工作.     

上海市青浦区基本职业卫生服务提供模式情景分析

通过对上海市青浦区基本职业卫生服务提供模式现状分析和青浦区构想的3种基本职业卫生服务提供模式情景SWOT分析,判断推导出公私合作提供基本职业卫生服务模式是否适合今后青浦区基本职业卫生服务的发展和需求的模式,并在此基础上提出"建立区、镇两级政府为主导,区、镇(街道)、村三级公立卫生服务网络为基础、市级公立职业卫生服务机构为依托、民营职业卫生服务机构为补充、区职业卫生行业协会为平台的青浦区基本职业卫生服务公私合作模式"的总体框架与保障措施。     

Undergraduate training in occupational health at Kocaeli University Medical School: a Turkish experience

Processes and conditions of production may produce unhealthy effects. Both must therefore be included in the education of health care personnel. Vocational training in occupational health at Kocaeli University Medical School, Turkey aims to demonstrate students that occupational health is a specific and important area of work within the context of primary health care. This research is a cross-sectional study. It was planned as a three stage study: 1- reviewing literature and grouping of countries according to their occupational health curricula; 2- reviewing the occupational health programs of medical schools in Turkey, and 3- recommendations for an occupational health curriculum to include an occupational health vocational training period of one week in the two month public health education program for medical interns. During this experience, senior students would be assigned to workplace health units. Of 283 medical schools found on the web, with occupational health teaching, only 20 have a curriculum that includes training in workplace health care units. In Turkey, there is no structured practical education on occupational health. In the third part of this study, we initiated at Kocaeli University School of Medicine's curriculum, a new occupational health education model applied in the workplace health units of factories. Practical experience of occupational health in the workplace is useful in introducing the community-based approach to occupational health in undergraduate medical education and understanding the determinants of health in industry.     

ICMM职业健康风险评估模型在某金融机具工程项目职业病危害评价中的应用

目的探讨国际采矿与金属委员会（ICMM）职业健康风险评估模型在某金融机具工程项目职业健康风险评估中的适用性,为我国制定相关标准或规范以及职业卫生评价提供科学依据。方法运用该模型的矩阵法和定量法分别对某金融机具工程项目关键岗位的职业病危害进行职业健康风险评估,并对2种方法结果的一致性进行比较,同时运用现场检测结果和相关研究进行结果验证。结果该模型矩阵法和定量法得出结果一致的岗位有2个,不一致的岗位有5个。矩阵法将机加车间车工、铣工、磨工接触噪声所致噪声聋和组装车间装配接触手传振动所致手臂振动病定为中风险,与现场检测结果和相关研究一致。定量法将电子车间焊接岗位的二氧化锡和铅烟的健康风险定为潜在风险,与现场检测结果和相关研究一致。其他岗位职业健康风险2种评估方法基本一致。结论 ICMM职业健康风险评估模型可用于某金融机具工程项目职业健康风险评估,矩阵法和定量法各有优缺点。     

The development of worker-controlled occupational health centers in Canada.

Over the past decade worker-controlled occupational health centers have been established in three Canadian provinces. This development has been a response to the slowness in recognizing occupational medicine in the Canadian medical community, the limited availability and questionable acceptability of existing services, as well as the growth of worker control in occupational health matters generally. The history, funding, organizational structure, personnel, resources, and programs of these worker-controlled centers are outlined, illustrating the extensive programs that can be provided despite small budgets of these operations. Advantages to workers include direct access to resources as well as expert professional advice with the focus on work place hazards. Furthermore, the centers provide for extensive interaction among workers on their common concerns. Disadvantages of the model include restricted access to work places associated with frequent distrust of employers. Employer-based and university-based models are compared to worker-controlled centers, and it is suggested that the latter may influence the pattern of practice of occupational health as well as the ability of workers and their unions to promote improved occupational health and safety conditions.     

Prevention pathways: application of the critical path methodology in occupational health services

Occupational health services face important changes as a result of changes in work environment, changing health and safety concepts, and legislation. To ensure good quality at a good price, it is important to control the processes in occupational health services. The concept of "prevention pathways" is presented for the management of occupational health services. The model is based on the critical pathway concept. The approach is illustrated by means of a case study performed in a Belgian occupational health service. A prevention pathway for the evaluation of chemical risks at the workplace was constructed. The prevention pathway methodology revealed inefficiencies and quality problems in the current practice of chemical risk assessment and biomonitoring. The case shows how prevention pathways can be used to pilot the members of a multidisciplinary team by focusing on a specific occupational risk.     

Job load and hazard analysis: a method for the analysis of workplace conditions for occupational health care

One requirement for successful occupational health care is reliable information on occupational hazards. The aim of this study was to develop a simple, standardised method for workplace investigations for use in occupational health care. The theoretical framework of the method comprises the stress-strain model, the hazard-danger model, and risk behaviour theory. The new method, termed job load and hazard analysis, includes four stages: identification of hazards, their evaluation, conclusions and proposals, and follow up. Different methods are available for hazard identification. The identification starts with a rough analysis of five factors, chemical hazards, physical hazards, physical load, mental stress, and accident risk. Hazards and stress factors are assessed with an ordinal scale. Specialised methods are used if all hazards cannot otherwise be identified. The analytical procedure comprises: detection of hazards through observations and interviews at the workplace and with a questionnaire; assessment of findings as teamwork; and evaluation of the results of these assessments to yield conclusions and proposals made by occupational health care personnel. A data processing system has been developed for data storage and future use. The method has functioned in practice, improving the contents of the occupational health care programme and generating preventive measures. The method offers many new possibilities for controlling occupational hazards and studying relations between working conditions and workers' health.     

小工业社区职业卫生服务模式效果评估

[目的 ]评估上海桃浦地区试行的小工业社区职业卫生服务模式。 [方法 ]分析接受社区职业卫生服务的10 9家小工业的职业卫生服务现状 ,并通过与基线调查资料对比 ,评估小工业社区职业卫生服务模式的近期效果。 [结果 ]社区职业卫生服务进展顺利 ,接受社区职业卫生签约服务的小工业的各项职业卫生评价指标均显著高于基线调查资料 ,且社区职业卫生服务发展态势良好。 [结论 ]通过分析与评估表明 ,小工业社区职业卫生服务近期效果显著。在目前小工业经济基础较为薄弱的情况下 ,通过社区职业卫生服务 ,能迅速提高小工业职业卫生水平 ,而且社区职业卫生服务适应WTO的需求 ,符合国家的政策导向     

Job load and hazard analysis: a method for the analysis of workplace conditions for occupational health care.

One requirement for successful occupational health care is reliable information on occupational hazards. The aim of this study was to develop a simple, standardised method for workplace investigations for use in occupational health care. The theoretical framework of the method comprises the stress-strain model, the hazard-danger model, and risk behaviour theory. The new method, termed job load and hazard analysis, includes four stages: identification of hazards, their evaluation, conclusions and proposals, and follow up. Different methods are available for hazard identification. The identification starts with a rough analysis of five factors, chemical hazards, physical hazards, physical load, mental stress, and accident risk. Hazards and stress factors are assessed with an ordinal scale. Specialised methods are used if all hazards cannot otherwise be identified. The analytical procedure comprises: detection of hazards through observations and interviews at the workplace and with a questionnaire; assessment of findings as teamwork; and evaluation of the results of these assessments to yield conclusions and proposals made by occupational health care personnel. A data processing system has been developed for data storage and future use. The method has functioned in practice, improving the contents of the occupational health care programme and generating preventive measures. The method offers many new possibilities for controlling occupational hazards and studying relations between working conditions and workers' health.     

大型企业职业病防治理论体系的创建和防治模式研究

目的探索我国大中型企业贯彻实施职业病防治法的有效理论体系和工作模式。方法采用系统论、控制论、关键点控制技术和职业安全卫生文化理论，充分借鉴国际职业安全卫生管理体系先进和核心理念，结合我国职业病防治法规标准的具体要求，考虑我国大型企业职业病防治工作特点。内容围绕着保护劳动者健康和工作场所职业安全卫生这一核心价值体系和核心目标，大型企业职业病防治理论体系和防治模式（CISCOD Mode）系统阐述了模式图及其结构、核心内涵、运行机制、外部支持系统，在此基础上，详细阐述了模式的系统性、层次性、关键点控制论、自律性和开放性特点。用人单位职业病防治理论体系包括四个层次：第一层为核心目标，即保护劳动者健康，实现工作场所卫生安全，开展职业病防治工作；第二层为实现核心目标的五大核心领域，包括方针政策目标、人力资源、制度机制、组织计划实施、工艺技术材料场所岗位。每个领域分三个层次，分别为要求、内容、实现的手段和条件；第三层为运行模式，包括职业卫生技术服务、定期评估与持续改进、社会对话与三方协调、职业卫生管理档案文件化四个方面；第四层为外部支持，包括职业病防治工作所需要的各种技术工具。结论CISCOD模式操作性和应用性很强，不仅为各大中型企业贯彻实施职业病防治法提供了一个适合我国实际情况的理论模式，还为行业自律、政府监管、工会主动参与职业病防治工作提供了客观和科学的手段与工具，研究成果具有重大的社会和经济效益。本模式不仅充分反映了国际职业安全卫生管理体系的最新理念和思想，也充分反映了大型企业职业病防治工作自身发展规律和内在需求，为中国乃至世界大中型企业职业卫生工作提供了极为有效的综合性自律模式，可进一步推动国际职业安全卫生管理体系所倡导的企业模式创建和开发。     

Occupational Therapy: Still at Work

Many occupational therapists are moving into the field of occupational health and safety. This move is a reflection of the political and economic climate of Australia as well as the changing legislation related to occupational health. Only New South Wales legislation will, however, be examined in this instance. Occupational therapy's move from a medical model to a holistic conceptual basis has also resulted in an increased awareness of primary prevention strategies and health promotion. The workplace-based strategies which occupational therapists can offer the corporate sector are many and varied and reflect the unique contribution to be made by the profession to occupational health and safety.     

基于两种ICMM风险评估模型研究某蓄电池生产企业职业健康风险

  目的  采用国际采矿与金属委员会（ICMM）职业健康风险评估方法评估某蓄电池企业职业健康风险,探讨该方法的适用性,为企业采取合适的职业卫生管理方法提供科学依据。
  方法  采用ICMM风险评估技术中定性评估矩阵和定量评估模型两种方法,对某蓄电池企业关键岗位工人的职业健康风险进行评估,并比较、分析方法的适用性。
  结果  矩阵法评估结果:极板打磨、分板、极板入壳、铸板、极板焊接等岗位接触铅所致铅中毒的健康风险为中等风险,分板、极板入壳、铸板等岗位接触噪声所致听力损失或噪声聋的健康风险为高风险,其他岗位健康风险水平为低风险或非常低风险。定量评估模型评估结果:和膏、分板打磨、极板打磨、分板、极板入壳、铸板、极板焊接等岗位接触铅所致铅中毒的健康风险为不可容忍风险,涂板、极板打磨、分板、极板入壳、铸板等岗位接触噪声所致听力损失或噪声聋的健康风险为不可容忍风险;其他岗位健康风险水平为可容忍的风险。
  结论  铅和噪声是蓄电池企业健康风险水平最高的危害因素,企业应采取改进生产工艺、调整原有防护设施和加强职业卫生管理等措施来降低职业健康风险。矩阵法和定量法评估结果各有偏倚,矩阵法风险评估结果所得危害等级比定量法的低。在实际应用中应结合现场检测结果和职业健康检查结果来综合考虑岗位健康风险水平。
     

The Union Health Center: A working model of clinical care linked to preventive occupational health services

As health care provision in the United States shifts to primary care settings, it is vital that new models of occupational health services be developed that link clinical care to prevention. The model program described in this paper was developed at the Union Health Center (UHC), a comprehensive health care center supported by the International Ladies Garment Workers Union (now the Union of Needletrades, Industrial and Textile Employees) serving a population of approximately 50,000 primarily minority, female garment workers in New York City. The objective of this paper is to describe a model occupational medicine program in a union-based comprehensive health center linking accessible clinical care with primary and secondary disease prevention efforts. To assess the presence of symptoms suggestive of occupational disease, a health status questionnaire was administered to female workers attending the UHC for routine health maintenance. Based on the results of this survey, an occupational medicine clinic was developed that integrated direct clinical care with worker and employer education and workplace hazard abatement. To assess the success of this new approach, selected cases of sentinel health events were tracked and a chart review was conducted after 3 years of clinic operation. Prior to initiation of the occupational medicine clinic, 64% (648) of the workers surveyed reported symptoms indicative of occupational illnesses. However, only 42 (4%) reported having been told by a physician that they had an occupational illness and only 4 (.4%) reported having filed a workers' compensation claim for an occupational disease. In the occupational medicine clinic established at the UHC, a health and safety specialist acts as a case manager, coordinating worker and employer education as well as workplace hazard abatement focused on disease prevention, ensuring that every case of occupational disease is treated as a potential sentinel health event. As examples of the success of this approach, index cases of rotator cuff tendonitis, lead poisoning, and formaldehyde overexposure in three patients and their preventative workplace follow-up, affecting approximately 150 workers at three worksites, are described. Work-related conditions diagnosed during the first 3 years of clinic operation included cumulative trauma disorders (141 cases), carpal tunnel syndrome (47 cases), low back disorders (33 cases), lead poisoning (20 cases), and respiratory disease (9 cases). This pilot project represents a new model for effective integration of clinical care and occupational disease prevention efforts within a primary care center. It could serve as a prototype for development of such services in other managed and primary care settings. Am. J. Ind. Med. 31:263–273, 1997. © 1997 Wiley-Liss, Inc.     

上海市1953年至2000年矽尘工种接触矩阵分析

[目的]根据上海市工作场所危害因素监测资料库中矽尘监测资料,尝试建立上海市1953年至2000年矽尘工种接触矩阵（JEM）。介绍JEM方法,以供探讨。[方法]运用EXCEL,ACCESS和STATA软件对矽尘监测资料作整理、分析、回归和推算。该资料库中有1953年至2000年矽尘的监测数据65561个。由工业卫生专家根据理论与其实践的认识评定行业及工种的强度级别;求取以不同年代（时段）、行业级别和工种级别三者分类交叉归并后的113个浓度均值;再求得对数实测浓度均值（应变量）与时段、行业级别和工种级别（自变量）之间的回归方程式,在时段上加用哑变量修饰使回归式更好地拟合各时段的波动变化,从回归式推算缺失值填补空格项。结合数据,讨论工种接触矩阵的意义、用途、方法和前景。[结果]建立了上海市1953年至2000年矽尘浓度9个时段、4个行业级别和4个工种级别的144个数据矩阵。工作场所的矽尘在48年内从高出工作标准数倍下降至接近或达到卫生标准,提示了职业卫生工作的重大成就,但曲线的波动也反映出相应的浓度问题。[结论]以上海市工作场所矽尘监测资料为基础,经统计分析建立了相应的工种接触矩阵,为职业卫生监测、职业病诊断、职业流行病学研究和劳动能力判断等方面的接触评定提供了数据基础。     

典型企业职业卫生工作探讨

在职业卫生工作中,树立典型,以点带面,全面推动职业卫生工作.典型的树立:选择工作做得较好的企业,按"职业卫生管理"等六个方面进行考评.经验:开发领导层;信息卡的应用;有害作业工种的分类和编码.存在问题:管理工作薄弱;现有档案过于简单;企业不能要求进行作业场所有害因素的定期监测和职工的定期、退休、调离时的职业性健康检查;职工自我保护意识弱.建议:加大执法力度,促进职防工作.