伤害

042 91 8　化工行业职业性机械伤害危险因素的病例 交叉方法研究 /金如锋…∥工业卫生与职业病 2 0 0 3 ,2 9(2 ) 88～ 91研究化工行业机械伤害的有关诱发因素 ,估计其作用强度。采用病例_交叉设计的方法。以操作和检修时受伤的化工工人为研究对象 ,每个对象在受伤后2d内完成调查 ,收集他们受伤前 1 0min、上一工作日同一段时间和受伤前 1周内有关诱发因素暴露的信息 ,用配对时间段方法和一般频数法进行分析 ,评估各种诱发因素的危险度。结果 ,一般频数法分析的结果表明 ,操作方法异常、设备工具缺陷、工作紧迫、注意力不集中、不使用…     

75例有色矿山职业伤害危险因素的病例-交叉研究

目的探索有色金属矿山职业伤害的危险因素及其作用强度。方法采用病例-交叉设计的研究方法。以某有色金属矿山2006年发生的75例非致死性职业伤害工人为对象，每个对象以相同的方式分别收集受伤前10min、上一工作日同一时段和受伤前1w内有关短暂暴露因素的信息，用配对时间段和一般频数法进行分析，评估各种短暂暴露因素的危险度。结果配对时间段分析的结果显示，工作条件、劳动管理和个人行为等11项危险因素OR值大于1；一般频数法分析：除“衣着不安全”、“未使用防护用品”的RR小于1，其他危险因素的RR值大于1。两种分析结果相比，一般频数法所得的95％CI的范围小。结论有多种可能诱发有色矿山职业伤害的危险因素。病例-交叉设计能有效地识别职业伤害的危险因素，揭示其作用强度。     

某有色金属矿山职业伤害瞬时危险因素研究

目的探索有色金属矿山职业伤害的瞬时危险因素，估计其作用强度，为及时纠正，采取应急措施，避免职业伤害的发生提供科学依据。方法用病例一交叉设计方法，研究职业伤害是否由某些称瞬时危险因素所诱发。以某有色金属企业下属4个矿山2006年131例职业伤害者为病例和对照。结果24h及1周配对时间段分析都有15项以上因素进入回归方程，其中与家人同事关系、是否执行安全员要求，是否进入不安全场所、是否执行作业规程，注意力是否集中、衣着是否安全、工作班次、受伤地点，设备运转，操作是否犯错等因素OR值大于1，是职业伤害的危险因素；一般频数法分析有工作条件、劳动管理以及个人因素方面的11项危险因素OR值大于1。结论有色金属矿山职业伤害发生与多项瞬时危险因素关联。预防和控制瞬时危险因素，保护重点人群，开展健康促进计划，可以有效地控制和减少职业伤害的发生。     

急性职业性手外伤的病例交叉研究

目的 用病例交叉研究方法探讨急性职业性手外伤的瞬时危险因素。方法 对166例急性职业性手外伤患者进行问卷调查，分别用配对间隔和日常频率2种方法计算各危险因素的危险度。结果 配对间隔研究无法计算OR值，但设备（工具）异常、非日常工作任务、操作方式改变和注意力不集中主要出现在伤害阶段。日常频率分析发现，设备（工具）异常和匆忙的RR值和95％可信区间下限均大于1；而加班和戴手套的RR值虽然大于1，但95％可信区间下限均小于1；非日常工作任务、操作方式改变、身体不适或生病、注意力不集中无法计算RR值。结论 设备（工具）异常和匆忙作业是导致手外伤发生的危险因素。手外伤的预防措施应着重于控制各种瞬时危险因素。     

职业伤害社会影响因素的回归分析

本文应用病例-对照研究探讨分析职业伤害的相关影响因素,为职业伤害的预防和控制提供依据。对象与方法1·研究对象选取全区制鞋企业2002年1月～2003年12月期间非致死性、因伤缺勤1天以上的受伤工人为病例组。对照组按1:2配对,随机抽取同行业、同工种、无职业伤害史的非本厂工人     

化工行业职业伤害个人危险因素的病例-对照研究

[目的]阐明化工行业工人的个人因素对职业伤害的影响,从而采取相应措施减少职业伤害的发生.[方法]应用病例-对照设计方法,进行多因素条件Logistic回归分析,比较化工行业受伤职工和未受伤职工有关个人特征(生活方式、工作经验、个性特征等)的差异.[结果]多因素条件Logistic回归分析的结果表明年龄较小、文化程度较低、总工龄较短、吸烟、以及个性维度中的情绪不稳定性得分较高,均可使职业伤害发生的危险性增高(OR>1,P<0.01).未发现饮酒、婚姻状况与职业伤害的相关.[结论]化工行业工人的个人因素与职业伤害的发生有关,应保护高危人群,以减少职业伤害的发生.     

金属制造业职业伤害危险因素的病例交叉研究

目的 探讨金属制造业职业伤害的瞬时危险因素.方法 采用配对病例交叉研究的方法,研究对象为广东省中山市4个职业伤害定点医院收治的来自金属制造业的由机械压力导致的职业意外伤害患者208人,采集伤害发生前30 min内危险因素的暴露情况,伤害发生前一天同一时段12种急性危险因素的暴露情况.结果 采用条件logistic回归分析,结果显示,更换工作岗位(OR =20.76,95％ CI=2.04～210.53),突然加班(OR =10.11,95％ CI=2.57～39.75)是职业伤害的危险因素(P＜0.01),而其他危险因素没有统计学意义.结论 更换工作岗位和突然加班是职业伤害的危险因素.     

台风伤害及其影响因素的现场流行病学研究

目的分析台风伤害的危险因素。方法采用现场流行病学调查方法,1:2配对的病例对照研究。对照组选伤害者邻居,按照同职业、同村庄、同性别和年龄±5岁配对。结果台风造成392人受伤住院治疗,50人死亡。伤害罹患率为27．3／10万,伤害致死率为11．3％,伤害死亡率3．1／10万。调查了209名受伤者和31名死亡者。发现伤害主要发生在台风来临前,其中台风来临前1～6小时之间有病例155例,占64．6％。209例伤害病例中,67．5％的病例曾得到过台风预警,但138名应答者中重视预警的只有47人,仅占34．0％。发现“台风来临时不在家中”[调整OR值(MH)=3．9 (95％CI:1．9～7．7)]、“台风来临前未得到预警”[调整OR值(MH)=3．3(95％CI:1．3～8．6)]和“虽得到预警但不重视”[调整OR值(MH)=17(95％CI:4．2～68)]是台风伤害的危险因素。结论外出、不重视预警是台风伤害的危险因素,应加强台风来临的预警宣传力度。     

近海海产品与甲型肝炎关系的病例对照研究

目的：探讨甲型肝炎流行的食源性危险因素。方法：采用1：1配比的病例对照研究方法，共调查126例急性甲型肝炎患者和126例对照，计算OR及OR的95％可信限。结果：生食蚬子、牡蛎、夹板虾和街头烧烤是引起甲肝流行的主要食源性因素。结论：有关部门应加强近海贝类和甲壳类的卫生管理和甲肝病毒的监测。     

上海市宝山区肺癌危险因素的病例对照研究

为了探讨室内装修等环境和生活危险因素与肺癌的关系。研究人员采用1：1频数配对的病例对照研究方法，以2007年确诊的163例肺癌患者为病例组，选择在年龄、性别、住址方面相匹配的对象为对照组，进行条件Logistic回归分析相关的危险因素。     

Transient risk factors for acute traumatic hand injuries: a case-crossover study in Hong Kong

Objectives

To identify the remediable transient risk factors of occupational hand injuries in Hong Kong in order to guide the development of prevention strategies.

Methods

The case‐crossover study design was adopted. Study subjects were workers with acute hand injuries presenting to the government Occupational Medicine Unit for compensation claims within 90 days from the date of injury. Detailed information on exposures to specific transient factors during the 60 minutes prior to the occurrence of the injury, during the same time interval on the day prior to the injury, as well as the usual exposure during the past work‐month was obtained through telephone interviews. Both matched‐pair interval approach and usual frequency approach were adopted to assess the associations between transient exposures in the workplace and the short‐term risk of sustaining a hand injury.

Results

A total of 196 injured workers were interviewed. The results of the matched‐pair interval analysis matched well with the results obtained using the usual frequency analysis. Seven significant transient risk factors were identified: using malfunctioning equipment/materials, using a different work method, performing an unusual work task, working overtime, feeling ill, being distracted and rushing, with odds ratios ranging from 10.5 to 26.0 in the matched‐pair interval analysis and relative risks ranging between 8.0 and 28.3 with the usual frequency analysis. Wearing gloves was found to have an insignificant protective effect on the occurrence of hand injury in both analyses.

Conclusions

Using the case‐crossover study design for acute occupational hand injuries, seven transient risk factors that were mostly modifiable were identified. It is suggested that workers and their employers should increase their awareness of these risk factors, and efforts should be made to avoid exposures to these factors by means of engineering and administrative controls supplemented by safety education and training.     

A case-crossover study of occupational traumatic hand injury: methods and initial findings

BACKGROUND: Acute hand injury is the leading cause of occupational injury treated in United States' hospital emergency departments (e.g., laceration, crush or fracture). To identify risk factors for traumatic hand injuries, we conducted a case-crossover study of transient exposures (e.g., being rushed) for acute occupational traumatic hand injury. METHODS: The case-crossover method, which uses subjects as their own controls, was used to identify risk factors for occupational hand injury. Two hundred and thirty-two subjects were recruited from 17 occupational health clinics in New England and interviewed by telephone a median of 1.2 days after their injury. The a priori hazard period was defined as 10 min before the injury. Two control periods were used: one was 60-70 min prior to the injury (matched-pair interval analysis); the other was the total work-time exposed, on average, in the previous month (usual frequency analysis). RESULTS: In the usual frequency analysis, the relative risk for using malfunctioning or different-from-usual equipment or tools in the hazard period was 25.5 (95% confidence interval = 18.4-35.2). Relative risks were also significantly elevated for performing a task using an unusual work method, doing an unusual task, being distracted, or being rushed. Wearing gloves appeared to be protective (relative risk = 0.8, 95% CI = 0.5-1.2). Matched-pair interval analysis, where appropriate, provided similar findings but had much wider confidence intervals. CONCLUSIONS: This study demonstrates that the case-crossover design is a feasible and efficient method for studying transient risk factors for sudden-onset traumatic occupational hand injury. The usual frequency analysis proved more useful than the match-pair approach to control period selection.     

石化企业工人膀胱癌职业危险因素的病例对照研究

[目的]探讨石化企业工人膀胱癌的职业危险因素。[方法]对21例膀胱癌病人按年龄、性别、民族进行1∶4匹配,年龄相差不超过3岁,采用自行设计的调查表调查膀胱癌的危险因素,所得资料利用SAS 8.0、Excel 2003等软件进行单因素和多因素条件logistic回归分析。[结果]单因素分析显示化工岗位工人患膀胱癌危险性是非化工岗位工人的8倍,95%可信区间为1.465~43.678;暴露工龄越长,其发生膀胱癌的危险性越大。多因素分析同样证实化工岗位是化工企业工人膀胱癌的职业危险因素。[结论]从事化工岗位工作及暴露工龄长是使石化企业工人膀胱癌危险性增加的两个主要职业因素。     

有色金属矿山职业伤害危险因素的病例对照研究

目的探索有色金属矿山职业伤害的危险因素及其关联程度。方法采用病例对照研究方法,以职业伤害者为病例,未发生职业伤害的职工为对照。结果矿山职工安全认知因素得分越高,职业伤害发生的可能性越小。职业类型、工作岗位、工种、总工龄、工作设备运转、物体摆放、处在不安全位置、感到工作有压力、文化程度是职业伤害发生的危险因素。结论有色金属公司矿山发生职业伤害与职工个人、劳动条件、劳动组织等方面关联。职业伤害预防和控制应考虑作业场所的危险因素,保护重点人群,开展健康促进计划。     

6 Sigma管理方法对消毒供应科工作质量的影响

目的：探讨消毒供应科应用6 Sigma管理方法对消毒供应质量的影响。方法采用6 Sigma管理方法,分析并评估影响质量的因素,优化消毒供应流程,对实施前6个月及实施后6个月消毒供应质量进行评估。结果实施6 Sigma模式后器械更换频次、耗损较实施前有显著下降（P〈0.05）,满意度较实施前有显著升高（P〈0.05）。实施后锐器伤有显著下降（P〈0.05）,包装合格率及无菌物品合格率均显著上升（P〈0.05）。实施后消毒物品丢失率、循环时间及感染发生率较实施前具有显著下降（P〈0.05）。结论6Sigma管理方法有助于优化流程,是提高消毒供应工作质量的重要管理方法。     

A case-crossover study of transient risk factors for occupational acute hand injury

Background: Workers with acute hand injuries account for over 1 000 000 emergency department visits annually in the United States.

Aims: To determine potential transient risk factors for occupational acute hand injury.

Methods: Subjects were recruited from 23 occupational health clinics in five northeastern states in the USA. In a telephone interview, subjects were asked to report the occurrence of seven potential risk factors within a 90-minute time period before an acute hand injury. Each case also provided control information on exposures during the month before the injury. The self-matched feature of the study design controlled for stable between-person confounders.

Results: A total of 1166 subjects were interviewed (891 men, 275 women), with a mean age (SD) of 37.2 years (11.4). The median time interval between injury and interview was 1.3 days. Sixty three per cent of subjects had a laceration. The relative risk of a hand injury was increased when working with equipment, tools, or work pieces not performing as expected (11.0, 95% CI 9.4 to 12.8), or when using a different work method to do a task (10.5, 95% CI 8.7 to 12.7). Other transient factors in decreasing order of relative risk were doing an unusual task, being distracted, and being rushed. Wearing gloves reduced the relative risk by 60% (0.4, 95% CI 0.3 to 0.5). Occupational category, job experience, and safety training were found to alter several of these effects.

Conclusion: The results suggest the importance of these transient, potentially modifiable factors in the aetiology of acute hand injury at work. Attempts to modify these exposures by various strategies may reduce the incidence of acute hand injury at work.

     

A reliability study of potential risk factors for acute traumatic occupational hand injuries

BACKGROUND: A reliability study of transient workplace exposures was conducted within a case-crossover study of acute traumatic occupational hand injuries. Exposures examined included features of work equipment (unusual performance of equipment or materials, glove use), work practices (performing an uncommon work task, using an unusual work method), and worker-related factors (being rushed, distracted, ill, or working overtime). METHODS: Interviewers administered a follow-up questionnaire about exposure up to 4 days after the initial interview. The reliability of the usual frequency of exposure in the past month, exposure reported at the time of the injury, and the degree to which subjects had confidence in the accuracy of their memory for exposure was assessed. RESULTS: The test-retest reliability for the estimated number of hours of exposure during the past month was high for six of the eight potential risk factors (intraclass correlation coefficients (ICC) ranging from 0.84-0.99). ICC for the frequency per month and minutes per exposure, used to calculate the estimated number of hours per month, ranged from 0.12-0.99 and 0.49-0.99, respectively. Agreement of reported exposure at the time of the injury, evaluated using the kappa statistic, ranged from substantial agreement to perfect agreement (0.65-1.0). However, for some factors, there was little or no reported exposure. Most subjects (74-100%) reported being "very confident" or "certain" in their memory for each exposure. CONCLUSIONS: These findings suggest that the frequency and duration of unusual transient workplace exposures can be reliably recalled by subjects interviewed by telephone within 4 days of an injury.     

广州市护士注射锐器伤相关危险因素的流行病学研究

目的：了解注射相关锐器伤的危险因素，提供安全注射指导。方法：采用现况调查和1：1配比研究，对广州市13所医院3010名护士锐器伤的流行特征及危险因素进行分析。结果：87．5％的护士有过锐器伤的经历，锐器伤的月发生率为37．6％，发生密度为每人每月0．84次。锐器伤的月发生率与职称相关，锐器伤的经历与护龄、婚姻状况、雇用形式、职称有关。66％的锐器伤集中发生在白天，51％的锐器伤发生在治疗室。logistic多元回归分析显示，锐器伤发生的危险因素除与接触针头的频率、操作者的知识、认知、个性等有关外，还与注射前掰安瓿不使用纱布、注射中工作空间拥挤噪杂、护理对象有较多不合作病人、注射后有回套针帽的习惯等因素有关。结论：调查人群中锐器伤的发生非常普遍，其流行特征与危险因素的分布不同于国外研究结论。研究结果可为国内医院感染控制部门及卫生行政部门制订安全注射的政策提供参考依据。