中国成年人呼吸防护用品适合性检验新型头面分栏研究

目的 为满足呼吸防护用品的适配性设计和测试需求,根据目前我国成年人头面测量数据提出2种新的分类(栏)方式:二元分栏和主成分分栏,并分析2种分栏对我国成人头面划分的适用性.方法 以近期我国3000名成年人头面尺寸测量数据为基础建立头面尺寸数据库,根据头面尺寸指标脸长-脸宽的二维分布提出我国成年人头面二元分栏.采用主成分分析对10项稳定的头面尺寸指标(最小额宽、脸宽、鄂宽、脸长、瞳孔间距、头宽、鼻突长、鼻宽、鼻梁宽、鼻长)分析后提出我国成年人头面主成分分栏.通过我国成年人头面数据在不同分栏的分布比例分析两类分栏对成人头面划分的适用性.结果 我国成年人头面二元分栏和主成分分栏分别将脸型分为10个型号和8个型号.总覆盖率分别为96.9%(男性95.4%,女性98.4%)和96.5%(男性95.1%,女性98.1%).各型号覆盖比例较为均匀,二元分栏各型号覆盖率在4.6%～21.7%之间,主成分分栏各型号覆盖率在10.4%～14.6%之间.对比分析国外头面分栏方法,美国洛斯阿拉莫斯实验室(LANL)全面罩分栏只能覆盖我国70.9%的人群,且各型号覆盖极不均匀,其中3个型号的覆盖率之和不足1%;美国国家职业安全卫生研究所(NIOSH)研制的二元分栏和主成分分栏能覆盖我国96.4%和95.9%的人群,但各型号分布不均匀,其二元分栏中5个型号仅覆盖6.3%的人群,主成分分栏中3个型号的覆盖率之和为7.2%.结论 根据我国成人头面数据提出的二元分栏和主成分分栏能代表国人头面尺寸分布,比国外分栏更适用.     

Head-and-face anthropometric survey of U.S. respirator users

Sizing data generated by the military for use in fitting respirators have been the normative basis for commercial respirator sizing. Anthropometric data developed for males and females of military age in the 1950s and 1960s are still in use today and form the only comprehensive body of information available on this subject. The twofold objective of this study was to: (1) develop an anthropometric database detailing the face size distributions of respirator users using both traditional measurement methods and three-dimensional scanning systems; and (2) use the database to establish fit test panels to be incorporated into the National Institute for Occupational Safety and Health's respirator certification and international standards. A stratified sampling plan was used with three age strata, two gender strata, and four race/ethnic group strata. The plan called for an equal sample size of 166 in each cell. Subjects were obtained at 41 sites from 8 states. In addition to height and weight, 18 facial dimensions and neck circumferences were measured using traditional methods. A total of 3997 subjects were measured using traditional methods, and 1013 of them were also scanned using a 3-D head scanner. As this was a volunteer sample, subjects did not appear in the specific proportions needed for the sampling plan. The resulting data were weighted to correspond to the U.S. population. This article presents the summary statistics for the traditional measurement data only. Multivariate analyses of the data from this study and military data revealed that using historical, military data would be inadequate for describing the anthropometric variability of the current U.S. work force.     

Social work in health settings in the U.S.A.

The review of the literature on social work focuses on the development of the profession in the United States, its involvement in health areas, and some of the recent directions with which writers in the profession are concerned. The diversity of the literature, as well as the culturally defined practice nature of the profession, make cross-national comparison of patterns of development of less value. The relationship between social work in health and mental health settings is mentioned, but the literature in psychiatric social work is large enough to be the subject of a separate survey. The profession is now represented in most primary-care-giving agencies in the United States, and in public health settings as well. Practitioners meet standards of training and education in common with nationally defined norms. Future concerns of social work in health include the effects of advancing medical technology on the patient care system, the increasing life expectancy with emphasis on old age, and controlling the increase in population.     

Smoking policies in U.S. hospitals: current status

Hospitals can and should restrict cigarette smoking to promote a healthy environment and to exemplify health promoting behavior. Questionnaires to determine policies and programs relating to smoking were sent to the administrative heads of 360 randomly selected hospitals across the nation. Returns were received from 330 hospitals for a response rate of 91.7%. Only 1.2% of the hospitals surveyed totally banned smoking. Visitors, patients who smoked, and physicians were seen as most resistant to smoking restrictions. The majority of hospitals (56.0%) continued to sell cigarettes on the premises. States whose economies are involved with tobacco are more permissive than the others to a significant degree. Since the hospital administration is the primary force in implementing smoking policy, the smoking behavior of the administrator may affect institutional smoking policies. It does affect their attitude about hospital employee smoking and the health professional's responsibility about smoking to a significant degree. Thus, hospitals are not demonstrating leadership in creating safe nonsmoking environments for the patients, nor in offering smoking education programs to the community.     

An assessment of critical anthropometric dimensions for predicting the fit of a half-mask respirator.

The purpose of this study was to determine if facial dimensions for a group of subjects were predictive of the fit factors measured while one brand of half-mask respirator was worn. Fit factors and 12 facial dimensions measured on 30 female and 38 male subjects were analyzed by correlation coefficients; weighted, multiple linear regression; and discriminant analysis. Data were analyzed for all subjects, gender subgroups, a race subgroup (whites only), and race/gender subgroups. Significant correlation coefficients with the log-transformed fit factors were found for four dimensions; four dimensions had significant coefficients in four or more multiple linear regression models. Only two dimensions had significant coefficients in four or more discriminant analysis models. Menton-subnasale (lower face) length was the only dimension included in all three of these groups. Gender-specific regression models had very high coefficient of determination values (R2 > 0.85). Discriminant analysis of the data for all subjects and race/gender subgroups found very good predictive scores for statistical software-generated models and menton-subnasale length alone; these scores were significantly better than those for the model with the respirator test panel dimensions (face length and lip width). These analyses found that facial dimensions were good predictors of respirator fit for those subjects wearing one brand of half-mask respirator. Lower face length was consistently indicated as being correlated or associated with fit. These results would indicate that dimensions other than those currently used may be more appropriate to define a half-mask respirator test panel.     

Pro bono work and nonmedical volunteerism among U.S. women physicians

To determine women physicians' rates of pro bono work and nonmedical volunteerism. We examined data from the Women Physician's Health Study (WPHS), a cross-sectional survey conducted in 1993-1994 of 4501 U.S. women physicians aged 30-70 years.     

Reconsidering the criteria for evaluating proposed screening programs: reflections from 4 current and former members of the U.S. Preventive services task force

In 1968, Wilson and Jungner published 10 "principles" for evaluating screening programs (Public Health Papers No. 34. Geneva, Switzerland: World Health Organization), criteria widely used since then. The 4 authors of this review (all current or former members of the U.S. Preventive Services Task Force) have found a different paradigm more useful for evaluating screening programs. This review was written independently of the USPSTF; the authors speak only for themselves and not for the USPSTF. They suggest evaluating screening programs not as a checklist but as a balance between the magnitude of benefits and the magnitude of harms, each estimated from a systematic review of the evidence. To emphasize a focus on health outcomes, the authors suggest reframing the target of screening as an umbrella concept: the "predictor of poor health." Evaluation groups should weigh health benefits and harms to estimate net benefits and then consider whether these net benefits justify the resources required. The final decision about implementation should be made by a democratic process that considers both the panel's evaluation of the evidence and nonevidence factors (e.g., resources available, other priorities, the informed population's preferences). The authors hope these suggestions stimulate further discussion about the optimal way to evaluate proposed screening programs.     

A new sampling technique that allows quantitative fit testing by using the employee's own respirator.

A new, in-mask sampling technique has been developed that enhances current quantitative respirator fit test methods. This new sampling technique eliminates the need for a permanently modified (probed) respirator for conducting fit tests. With this new technique, a sample was drawn from the breathing zone inside the respirator by means of a sampling adapter, which was temporarily attached between one of the air-purifying filters and the facepiece before a fit test was performed. To ensure that the performance of the respirator was not altered, the sampling adapter was designed so that all major functional aspects of the respirator were unchanged. This new sampling technique was evaluated on human test subjects by simultaneous sampling from a probed respirator by using two quantitative respirator fit test instruments. One instrument sampled through a conventional respirator probe; the other used the new method. Test results show that equivalent fit test data were obtained with both sampling techniques.     

Characterizing workforces exposed to current and emerging non-carbonaceous nanomaterials in the U.S.

Objective: Toxicology studies suggest that exposure to certain types of engineered nanomaterials (ENMs) may cause adverse health effects, but little is known about the workforce in the United States that produces or uses these materials. In addition, occupational exposure control strategies in this industry are not well characterized. This study identified U.S. ENM manufacturers and users (other than carbon nanotubes and nanofibers, which have been characterized elsewhere), determined workforce size, characterized types and quantities of materials used, occupational exposure control strategies, and the feasibility of occupational ENM exposure studies.

Methods: Eligible companies were identified and information was collected through phone surveys on nanomaterials produced or used, workforce size, location, work practices, and exposure control strategies. The companies were classified into groups for additional examinations.

Results: Forty-nine companies producing or using ENMs in the U.S. were identified. These companies employed at least 1,500 workers. Most companies produced or used some form of nanoscale metal. More than half of the eligible companies were suppliers for the coatings, composite materials, or general industries. Each company provided information about worker exposure reduction strategies through engineering controls, administrative controls, or personal protective equipment. Production-scale companies reported greater use of specific exposure control strategies for ENMs than laboratory-scale companies.

Conclusions: Workplaces producing or using ENMs report using engineering and administrative controls as well as personal protective equipment to control worker exposure. Industrywide exposure assessment studies appear feasible due to workforce size. However, more effort must be taken to target industries using specific ENMs based on known toxicological effects and health risks.     

上海市区1973至2005年癌症的发病趋势

目的了解企业职业人群的大肠癌筛查行为及相关因素,为提高职业人群大肠癌筛查参与率提出相应干预策略。方法于2016年采用自行设计的问卷,对上海市黄浦区某企业203名40~60岁职业人群的大肠癌筛查行为及其相关因素进行横断面调查。使用单因素和二元非条件logistic回归模型进行统计学分析。结果职业人群便隐血检测（FOBT）参与率为8.4%,直肠指检参与率为50.2%。多因素分析显示,文化程度较高（OR=4.27,95%CI为2.13~8.56）、正常体重及低体重（BMI < 24）（OR=1.93,95%CI为1.03~3.62）、大肠癌知识水平较高（OR=3.27,95%CI为1.76~6.09）是促使职业人群进行直肠指检的相关因素。结论职业人群FOBT、直肠指检参与率较低,企业应针对重点人群开展职工健康教育和促进活动,进一步提高大肠癌筛查的参与率。