上海市女性居民宫颈癌筛查知识和行为现状调查

[目的]了解上海市女性居民对宫颈癌筛查的知识和行为现状,为有针对性地开展健康教育和早期筛查工作提供科学依据。[方法]于2010年8—9月,对上海市7 909例15岁及以上女性居民的宫颈癌筛查知识和相关检查参与情况进行分析。[结果]对宫颈癌异常体征（7 908例）和宫颈细胞定期涂片筛查知识（7 907例）的知晓率：15岁及以上女性居民分别为54.29%和34.88%;居住于中心城区者知晓率较高（分别为59.49%和39.41%）;18～44岁年龄组的知晓率较高（分别为62.04%和40.30%）;大专及以上者的知晓率较高（分别为70.29%和49.33%）。18岁及以上的调查对象（6 973例）接受宫颈脱落细胞检查的比例为32.37%,不同年龄和文化程度者的差异均有统计学意义（P〈0.001）,其中18～44岁和未接受正规学校教育的女性受检比例较低（分别为26.96%和20.69%）。在曾经做过宫颈脱落细胞检查的2 223例女性居民中,最近一次检查距调查时的时间间隔中位数为2.00年。[结论]上海市女性居民对宫颈癌筛查的认知度较高,但参加相关筛查的比例相对较低。应加强该人群宫颈癌筛查知识的健康教育和行为指导,以提高其宫颈癌筛查的参与率及主动防癌健康检查的比例。     

上海某地区大肠癌筛查肠镜检查结果分析

目的分析某社区居民的大肠癌筛查肠镜结果,为大肠癌筛查项目实施提供参考依据。方法整理并分析2013年上海市川沙社区1,107例大便隐血检测(FOBT)结果为阳性的居民的肠镜检查结果资料。结果肠镜检查发现大肠癌7例、腺瘤108例、息肉296例、肠炎12例、其他19例、未发现病变665例。结论肠镜检查可提高大肠癌及其癌前期病变的早诊率,降低大肠癌的死亡率和未来发病率。     

上海市浦东新区书院社区2013年居民大肠癌筛查结果分析

目的 总结和分析书院社区居民大肠癌筛查情况,提出推动社区大肠癌筛查工作的相关建议.方法 利用病史问卷调查和粪便隐血试验（FOBT）对辖区内45～80岁居民进行初筛,对初筛的高危人群做进一步电子肠镜检查诊断,对检查结果进行分析.结果 2013年书院社区共开展大肠癌筛查3 765人,居民大肠癌筛查参与率为18.9％,初筛高危人群397人,阳性率为10.5％;高危人群中131人接受了肠镜检查,检查率为33.0％,其中确诊大肠癌2例,腺瘤29例,息肉13例.结论 在社区开展病史问卷调查、粪便隐血试验和结肠镜检查有利于大肠癌及癌前病变的早期诊断及治疗.但当前社区居民大肠癌筛查参与率及肠镜检查率均偏低,需加强居民大肠癌癌筛查的宣教动员工作.     

上海市奉贤区社区居民大肠癌筛查结果分析

目的进行上海市奉贤区社区居民大肠癌筛查,探讨社区居民大肠癌筛查的效果。方法以《上海市重大公共卫生服务项目社区居民大肠癌筛查工作规范》为依据,对40~79岁上海市奉贤区户籍居民进行大肠癌筛查。以危险度评估问卷调查及粪便隐血试验(FOBT)作为初筛,初筛阳性者行全结肠镜检查,并对结果进行分析。结果实际筛查46 501人,初筛阳性率为24.07%,无论男性还是女性,70岁以上人群初筛阳性率最高;肠镜检查依从率为45.90%,总病变检出率21.92%,总病变检出率随着年龄增长呈上升的趋势,不同年龄组总病变检出率比较,差异有统计学意义(χ2=21.25,P0.05),并且男性显著高于女性,差异有统计学意义(χ2=152.23,P0.05);单一评估阳性组的肠镜检查依从率、总病变检出率、癌及癌前病变检出率分别为40.18%、16.41%和9.42%,均低于单一FOBT阳性组(分别为47.94%、23.06%和13.76%),差异均有统计学意义(P0.05)。结论危险度评估结合FOBT可以有效地检出上海市奉贤区居民大肠癌及癌前病变,对于降低大肠癌的死亡率和发病率具有重要意义。     

嘉定镇社区居民大肠癌不同筛查模式的效果评价

【目的】了解上海市嘉定镇社区居民采取不同方式开展大肠癌筛查的效果?【方法】采用常态化门诊主动筛查和集中式被动筛查两种方式?对符合筛查条件的居民开展大肠癌危险度评估和2次大便隐血检查?对初筛阳性者通知其肠镜检查?掌握动态?做好追踪随访?并对确诊为大肠癌的患者纳入肿瘤人群管理?【结果】4 455名参与大肠癌筛查居民中采取门诊筛查的居民占30.75%?被动筛查的占69.25%?女性占58.38%?男性占41.62%?年龄分组以50~69岁居多?占87.70%?初筛总阳性率为20.97%?两种筛查方式相比?门诊主动筛查的初筛阳性率高于被动筛查(P0.01)?肠镜检查顺应性方面?门诊主动筛查的肠镜检查率远远高于集中式被动筛查?P0.01?通过肠镜检查发现?门诊主动筛查组大肠癌及其癌前病变的检出率均高于集中式被动筛查?【结论】建立以门诊主动筛查为主?集中式被动筛查为辅助的筛查模式?能充分发挥大肠癌筛查的整体作用?     

2013年上海市奉贤区泰日社区大肠癌筛查结果

目的了解上海市奉贤区泰日社区大肠癌筛查情况,探讨大肠癌筛查效果。方法按照《上海市社区居民大肠癌筛查实施方案》,对50~79岁奉贤区泰日社区常住居民采用危险度评估问卷调查和大便隐血试验(FOBT)相结合的方法进行初筛,对初筛阳性的人群进行电子肠镜检查。结果在参加大肠癌筛查的2 643人中,确定初筛阳性者995例,阳性率为37.6%。其中522例进行了肠镜检查,肠镜检查率为52.46%。检出病变117例,病变检出率为22.41%,其中男性检出率为31.28%,女性检出率为16.40%,差异有统计学意义(χ2=16.01,P0.01);筛查出大肠癌3例,大肠腺瘤79例,非腺瘤性息肉35例。结论危险度评估和FOBT相结合的筛查方法可以有效检出早期大肠癌和癌前病变,对于降低大肠癌的死亡率和发病率具有重要意义;泰日社区大肠癌检出率相对较高,病变检出率男性高于女性,且随着年龄的增长而升高,应着重加强重点人群的大肠癌防治工作。     

上海市宝山区18237名居民大肠癌筛查情况及肠镜顺应性影响因素分析

目的了解该地区居民大肠癌高危人群、肠镜检查率等现况,为上海市大肠癌防治工作提供参考依据。方法以2013年5月-12月上海市宝山区参加大肠癌筛查项目的居民为研究对象,采用《上海市社区居民大肠癌筛查危险度评估表》与胶体金法粪便隐血检测(FOBT)相结合的方法,分析宝山区居民大肠癌初筛和肠镜顺应性情况,并对不同性别、年龄的居民筛查结果及其肠镜检查情况进行比较。结果上海市宝山区内18 237人参与大肠癌筛查,大肠癌筛查危险评估阳性2 731人(14.95%),FOBT检测结果阳性3 471人(19%),初筛高危人群共5 601人,初筛阳性率为30.65%。男女初筛阳性率差异无统计学意义(P0.05);2 326民高危人群进行全肠镜检查,肠镜检查顺应性为42.19%,影响肠镜检查顺应性的因素包括:年龄(OR=0.836,95%CI:0.767～0.912),学历(OR=1.271,95%CI:1.137～1.419),一级亲属癌症史(OR=0.682,95%CI:0.544～0.864),肠息肉史(OR=1.618,95%CI:1.270～2.061)。结论有针对性的开展大肠癌高危人群筛查,有利于提高大肠癌患者的早诊率、治疗率,对改善大肠癌患者生存质量意义重大。     

上海市宝山区某社区大肠癌筛查结果分析

目的分析上海社区大肠癌筛查数据,为今后开展大肠癌筛查提供基础数据。方法于2014年5—12月,用"危险度评估表"和两次大便隐血试验,对宝山区某社区8 386名常住居民开展大肠癌初筛,初筛阳性者建议到定点医院做肠镜检查。结果筛查对象中50~74岁年龄段占78.42%;在大肠癌危险因素中,慢性便秘、慢性阑尾炎或阑尾切除和慢性胆囊炎或胆囊切除所占比例较高,分别为11.71%、11.47%和12.57%;初筛阳性比例为34.27%,初筛阳性中做肠镜的比例为27.21%。未做肠镜最主要的原因有担心不适和认为没有必要;筛查出大肠癌前病变149例,大肠癌16例,大肠癌检出率为190.74/10万,其中男性9例,大肠癌检出率为270.43/10万,女性7例,大肠癌检出率为138.39/10万;其中早期6例,早期检出率为31.58%。结论上海市开展大肠癌筛查,对于大肠癌的早期发现、早期治疗具有积极意义,今后应更加细化筛查年龄、加强大肠癌相关知识的宣传,提高肠镜等检查的顺应性。     

上海市某社区居民大肠癌筛查分析

目的了解上海市某社区居民大肠癌筛查情况,为今后深入开展大肠癌筛查工作提供依据。方法对辖区5294名居民采用问卷调查法及大便隐血试验(FOBT)进行初筛,对于初筛阳性者建议到上海市定点医院做肠镜检查,并对筛查结果进行分析。结果在5294名居民中,男性2171人(41.01%),女性3123人(58.99%);平均年龄为(63.68±7.94)岁。慢性便秘、慢性胆囊炎、慢性阑尾炎在大肠癌危险因素分布中占的比例较高,分别为10.07%、9.84%和9.41%。本次初筛阳性例数为1847人,阳性率为34.89%,其中,男性774人,女性1073人,男女性别无统计学意义(P0.05)。肠镜检查人数为312人,检查率为16.89%,镜检查出癌前病变21例,检出率为396.68/10~5,确诊为大肠癌的有6例,大肠癌检出率为72.34/10~5。结论上海市开展社区居民大肠癌筛查项目,对大肠癌早发现、早诊断、早期治疗具有十分重要的意义。今后工作中,应该加强宣传和解释工作。同时,加大医疗保险和资金支持的力度,有效提高大肠癌筛查的顺应性,让这项活动惠及更多的市民。     

上海市某社区大肠癌筛查阳性居民知信行现状及肠镜检查意愿

【目的】了解大肠癌筛查阳性居民的大肠癌及其筛查知识、信念及行为现状,探讨居民肠镜检查参与意愿的影响因素。【方法】选取上海某社区2016年首次参加大肠癌筛查,并且筛查结果为阳性的居民共149名为调查对象,采用自行设计的问卷,以集中现场调查和入户调查相结合的形式对大肠癌筛查阳性居民进行调查。问卷内容包括居民的基本情况、大肠癌及其筛查的知信行情况和肠镜检查参与意愿情况。【结果】阳性居民的大肠癌及其筛查知识得分较好、一般、较差分别为34名(占22.8%)、38名(占25.5%)、77名(占51.7%);信念得分较好、一般、较差分别为12名(8.1%)、63名(42.3%)、74名(49.6%);在后续肠镜检查意愿方面,其中仅筛查危险度评估表阳性、仅便隐血阳性、评估表和便隐血均阳性的愿意去做肠镜检查的人数分别为82名(占55.03%)、87名(58.38%)、92名(占61.74%)。Spearman秩相关分析显示,知识与信念(rS=0.257,P0.05),知识与肠镜检查参与意愿(rS=0.345,P0.05),信念与肠镜检查参与意愿(rS=0.331,P0.05)间均呈正相关关系。不同性别、医保类型、月收入、体检次数、健康关注程度、到定点医院时间和就近二级医院的时间居民的肠镜检查意愿比较,差异无统计学意义(P0.05);不同知识、信念得分的居民肠镜检查意愿比较,差异有统计学意义(P0.05)。二分类非条件logistic回归分析显示,仅知识得分和信念得分对大肠癌筛查阳性居民的肠镜检查参与意愿的影响有统计学意义(P0.05)。【结论】该社区居民大肠癌筛查知识、信念、行为水平均需提高,筛查知识及筛查信念是阳性居民进一步做肠镜检查意愿的影响因素。     

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.     

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.     

Assessing occupational and environmental exposure

Exposure assessment is a poorly understood component of the science of epidemiology. The relationship between exposure to chemicals and ill-health outcomes is often calculated using crude exposure measures such as ever/never exposed or duration. When investigating subtle effects, exposures need to be characterized much more fully in terms of intensity, frequency, duration and route. While occupational exposures tend to be much greater than those experienced from the wider environment there is a need to remember that, for many chemicals, exposure can occur occupationally, environmentally and through consumer use of products containing the material of interest. Inhalation exposure has generally been the traditional focus for most epidemiological investigations but there is now growing awareness of the importance of the dermal and ingested routes of contact and internalization. Quantification of the exposure also needs to be related to a biological mechanism of action and exposure metrics need to be selected accordingly. Occupational exposures can generally be measured using simple well-validated techniques. Environmental exposures require much more sensitive instruments and are more difficult to assess. Exposure modelling, particularly for the environmental fate of chemicals has undergone many recent developments and Monte Carlo techniques can be used to characterize model uncertainty and variability. This approach to exposure assessment can now be used in the setting of the wider environment and will enable a far better understanding of the relationship between exposure and disease.     

Mercury toxicity due to the smelting of placer gold recovered by mercury amalgam

A 19-year-old man developed tremor in both hands and fatigue after starting work at a placer gold mine where he was exposed to mercury-gold amalgam. Examination revealed an intention tremor, dysdiadochokinesis and mild rigidity. The 24-h urinary mercury concentration reached a peak of 715 nmol/l (143 ug/l) shortly before the clinical examination, after which he was removed from working in the gold room [Mercury No. Adverse Effect Level: 250 nmol/l (50 ug/l)]. On review 7 weeks later his tremor had almost resolved and the dysdiadochokinesis and rigidity had gone. The 24-h urinary mercury concentration had fallen to 160 nmol/l (32 ug/l). The principal exposure to mercury was considered to be the smelting of retorted gold with previously unrecognized residual mercury in it. The peak air concentration of mercury vapour during gold smelting was 0.533 mg/m3 (Mercury Vapour ACGIH TLV: 0.05 mg/m3 TWA). Several engineering and procedural controls were instituted. This episode occurred at another mine site, unrelated to Mount Isa Mines Limited.     

How Adults with Acquired Brain Damage Perceive Computer Training as a Rehabilitation Tool: A Focus-group Study

The aim of this study was to explore and describe how adult outpatients with acquired brain damage and referred to occupational therapy perceive computer training with the RehaCom programs, in order to evaluate the method of treatment as a tool in the rehabilitation of persons with cognitive disorders. By using focus-group discussions as a qualitative method of research when analysing the result, five themes with corresponding categories emerged, describing a development of understanding and learning about capacities. Themes describing how the participants could apply strategies to overcome shortcomings in daily occupations and the therapeutic role of the occupational therapist were identified as well. The result shows that a computer training program such as RehaCom can be used as an educational tool, for example, to guide a person who is trying to adopt compensatory strategies to avoid overload by taking pauses. It was found that anything the participants learned was also applicable to occupational performance in daily life.