某荧光灯制造企业汞接触工人职业健康状况及影响因素

[目的]了解某荧光灯制造企业汞接触工人职业健康状况,分析影响尿汞水平的因素。[方法]根据国家相关职业卫生标准对工作场所进行职业卫生学调查,并按照《工作场所空气中有害物质监测的采样规范》（GBZ159-2004）中规定的采样原则在每个岗位设置了一个采样点。对汞接触人员进行职业健康检查,检查内容包括问诊,内、外科,口腔科,实验室检查,B超,心电图等。共调查汞接触工人1031名,其中男性351名,女性680名,年龄20～57岁。[结果]该企业122个检测点空气中汞浓度范围为0．001～0．013mg／m3,均未超标。1031名工人尿汞浓度范围为0．22～58．71μg／m3,中位数为3．26μg／g肌酐,9人尿汞浓度超标,超标率0．87％。尿蛋白阳性198人,阳性率19．20％;神经系统异常113人,异常率10．96％。女性工人的尿汞水平（中位数为3．38μg／g肌酐）商于男性（中位数为3．07μ∥g肌酐）（P=0．036）;年龄与尿汞浓度呈正相关（r=-0．089,P=0．011）;工龄与尿汞浓度无相关。[结论]该企业各岗位空气中汞浓度均低于O．02mg／m。,O．87％的工人尿汞浓度超标。性别和年龄可能为尿汞浓度的影响因素。     

山西某地区汞环境污染及对居民肾功能的影响

[目的]探讨山西某地区土法炼金活动影响环境中汞（Hg）的分布以及对当地居民肾功能的影响。[方法]用原子荧光光谱法测定大气、水、粮食Hg含量以及居民尿Hg含量，尿N-乙酰-β-D氨基葡萄糖苷酶（NAG）用速率法测定，尿β2-微球蛋白（β2-MG）和尿微量白蛋白（mALB）测定采用终点法。[结果]污染区一年四季监测的大气Hg浓度为79～240ng／m^3，远高于对照区（P〈0．05）；河水中Hg含量超标19倍，达到（0．025±0．006）μg／L。污染区所产的玉米和粟米Hg含量分别为（0．006±0．003）mg／kg和（0．013±0．006）mg／kg，高于对照区（P〈0．05）；污染区居民尿Hg为（1．24±3．80）μg/L、尿β2-MG含量为（228．98±4．34）μg/gCr，均明显高于对照区（P〈0．05）。[结论]污染区炼金过程中产生的Hg对当地环境造成污染，并通过一定途径进入人体，引起当地人群体内Hg负荷水平的改变及肾功能异常。     

牙科银汞合金对儿童神经行为影响的研究

[目的]了解银汞合金充填物对儿童神经行为的影响。[方法]采用Achenbach儿童行为量表(CBCL)和自拟的儿童健康状况调查表(包括家长用表和学生用表)对徐汇区5所小学的三、四年级学生及其家长进行调查并收集学生的尿样,根据累计暴露量进行分组比较,并用SPSS10．0及儿童青少年心理测验系统小学版软件进行统计分析。[结果]男女生各组在人口学资料和学习成绩方面均无差异。三组尿汞水平差异无显著性,尿汞与累计暴露量之间有相关,相关系数为0．129。男生各组在多动(P=0．937)、攻击(P=0．853)等各方面无差异;女生各组在残忍(P=0．587)、社交退缩(P=0．150)等各方面也无差异。[结论]从本次研究的结果来看,目前尚不能认为银汞合金对儿童神经行为有影响。     

尿微量蛋白联合尿酶对高血压早期肾损害的诊断价值

目的探讨高血压早期肾损害的诊断标准。方法对50名健康者（对照组）和50例高血压患者（试验组）采用免疫散射比浊法检测尿转铁蛋白（TRF），终点法测微量白蛋白（mALB），免疫透射比浊法测定尿视黄醇结合蛋白（RBP），速率法测定尿N-乙酰氨基葡萄糖苷酶（NAG），酶法测定尿肌酐（Cr）。比较两组实验室指标结果。结果对照组：尿TRF／Cr为0．05±0．03mg／mmol，mALB为3．61±2．46mg／L，RBP／Cr为7．46±5．02ug／mmol，NAG／Cr为0．52±0．46U／mmol。试验组的TRF／Cr、mALB、RBP／Cr和NAG／Cr值较对照组的增高有统计学意义（P＜0．01）；两项指标联合检测，其阳性率分别为：TRF＋mALB：62％，TRF＋NAG：54％，mALB＋NAG：44％，TRF、mALB和NAG3项指标联合检测可使阳性率提高到78％，大大提高了阳性检出率。结论联合检测尿TRF、mALB及NAG是诊断高血压早期肾损害较灵敏的实验室指标。     

电子垃圾拆解集散地居民铅、镉、铜内暴露水平与淋巴细胞双微核率的关系

[目的]研究电子垃圾拆解集散地居民血尿铅、镉、铜的暴露水平和淋巴细胞双微核率的变化及其影响因素。[方法]选择某电子垃圾拆解集散地居民58人为暴露组（男性44人，女性14人），平均年龄为33．0岁；距离集散地50km，且无明显工业污染的农业区人群80人为对照组（男性41名，女性39名），平均年龄为43．7岁。采用石墨炉原子吸收光谱法检测血铅、血镉和尿铅、尿镉、尿铜含量，火焰原子吸收光谱法测定血清铜含量；胞质阻滞双微核实验测定淋巴细胞双微核率。[结果]暴露组居民血铅和尿铜中位数分别为0．52μmol／L和51．97μmol／mmol肌酐，均高于对照组（P〈0．05）。暴露组人群双微核率中位数（4‰）是对照组（1‰）的4倍，年龄是血镉增高的危险因素（OR=1．1，P〈0．01）；电子垃圾拆解职业暴露史是影响血铅水平及双微核率的危险因素（OR=2．9，P〈0．05；OR=6．7，P〈0．01）。[结论]电子垃圾拆解地居民血铅、尿铜水平及淋巴细胞双微核率均高于对照区居民。     

慢性汞暴露对人群肾脏功能的影响

目的 研究慢性汞暴露对人群肾脏功能的影响.方法 于2007年选择某温度计厂职工为研究对象,以该厂1996-2006年生产车间空气汞监测历史数据划分对照组(85人)和暴露组(101人),检测发汞、尿汞、累积暴露量(CEI)、肾小球滤过功能及肾小管吸收功能.结果 暴露组空气汞浓度、尿汞、发汞和累计暴露量均显著高于对照组(P<0.01),两组间血肌酐(Scr)和内生肌酐清除率(Ccr)的差异有统计学意义(P<0.01),暴露组尿N-乙酰-B-D葡萄糖苷酶(NAG)活力显著高于对照组(P<0.05),而传统肾脏损害指标血尿素氮(Bun)、a1-微球蛋白(a1-MG)和尿视黄醇结合蛋白(RBP)组间差异不明显(P>0.05);多元分析结果显示随发汞的升高,Scr显著升高,Ccr显著降低;NAG活力与尿汞呈显著正相关.结论 慢性汞暴露可造成.肾功能的损害,监测人群慢性汞暴露致肾脏损害时,Scr和Ccr可作为肾小球功能损伤的敏感效应指标,尿NAG可作为肾小管功能损害的敏感效应指标.     

不同妊娠期妇女尿碘与尿肌酐调查分析

目的了解杭州市不同妊娠期妇女尿碘与尿肌酐水平，为指导妊娠妇女科学补碘提供依据。方法采用酸消化砷-铈接触法检测水碘、尿碘；苦味酸法测定尿肌酐；硫代硫酸钠法测定盐碘。结果妊娠早、中、晚期妇女尿碘中位数分别为171．30μg/L、167．35μg/L、162．40μg/L，均明显低于对照组（251．90μg/L）（Z=-2．315，P=0．021；Z=-4．352，P=0．000；Z=-3．704，P=0．000）；妊娠早、中、晚期妇女尿碘值〈150μg/L比例分别占40．0％、45．1％、43．3％，其比例显著高于对照组（24．2％）（χ^2=5．551，P=0．018；χ^2=9．226，P=0．002；χ^2=7．647，P=0．006）；妊娠早、中、晚期妇女尿肌酐均值分别为1．37g／L、0．97g／L、0．81g／L，均显著低于对照组（1．68g／L）（P〈0．05），且妊娠中、晚期妇女尿肌酐水平显著低于妊娠早期（P〈0．05）。结论杭州市碘盐供应良好，妊娠妇女总体尿碘水平处于适宜范围，但随着孕龄的增加，尿碘和尿肌酐水平依次下降，妊娠中、晚期妇女更易发生碘营养不足；妊娠妇女需在食用碘盐基础上，定期进行碘营养监测，科学补碘。     

2005年济宁市部分粉尘接触工人肾功能指标调查

[目的]了解二氧化硅粉尘接触工人肾功能的变化。[方法]用放射免疫分析法测定二氧化硅粉尘接触工人和对照组尿白蛋白(ALB),β2-微球蛋白(β2-MG),用比色法测定尿N-乙酰-D-氨基葡萄糖苷酶(NAG)含量。[结果]二氧化硅粉尘接触工人和对照组尿白ALB分别为(1.11±0.97)和(0.56±0.32)g/mol(P<0.01),β2-MG分别为(13.87±10.48)和(10.08±6.36)mg/mol(P<0.05,NAG分别为(2.16±3.67)和(1.04±0.81)U/nmol(P<0.05),二氧化硅粉尘接触工人尿白ALB、β2-MG和NAG显著高于对照组,其含量增加与二氧化硅粉尘接触时间有关。[结论]二氧化硅粉尘可引起工人肾功能改变。     

内蒙古不同浓度砷暴露人群尿砷代谢产物研究

目的 测定内蒙古地区饮用高砷水人群尿砷代谢产物，探讨不同人群砷代谢的特点。方法 采用氢化物发生原子吸收分光光度法检测尿中不同形态的砷代谢产物。结果 2个暴露组人群尿中无机砷（iAs，inorganic arserlic）、甲基砷（MMA，monomethylarsine）、二甲基砷（DMA．dimethylarsine）和总砷（TAs，total arserlic）均高于对照组（P〈0．05）；同样砷暴露水平下，尿中各形态砷含量及其相对比在不同性别问的差异均无统计学意义（P〉0．05），儿童DMA／MMA和DMA％高于成人（P〈0．05），MMA％低于成人（P〈0．05）；2个暴露组儿童、成人分别与对照组比较，暴露组MMA／ias、DMA／MMA、DMA／iAs、DMA％显降低（P〈0．05），而iAs％、MMA％显增高（P〈0．05）；高暴露组与低暴露组相比，儿童DMA／MMA、DMA／iAs、DMA％显增高（P〈0．05），iAs％、MMA％显降低（P〈0．05）。结论 相同砷暴露水平下，男女对砷的甲基化能力无差别，儿童二甲基化能力高于成人。高砷暴露可能降低人群对砷的生物甲基化能力。[编按]     

终末期肾病患者血清氨基酸水平的变化

目的用高效毛细管电泳法分析终末期肾病（ESRD）患者与正常人血清游离氨基酸水平的变化，并探讨氨基酸与患者血白蛋白、血红蛋白和转铁蛋白的相互关系。方法选择ESRD（内生肌酐清除率〈0．25ml／s）尚未开始透析的患者共40例，除外活动性肝脏疾病、急性感染、慢性特异性感染和肿瘤患者；健康对照者24例。常规检测血白蛋白、转铁蛋白、血红蛋白和肌酐的水平，用高效毛细管电泳仪检测血清氨基酸水平。结果与正常人相比，ESRD患者血清非必需氨基酸中酪氨酸浓度显著降低，而半胱氨酸、脯氨酸浓度显著升高（P〈0．05）；缬氨酸／甘氨酸、丝氨酸／甘氨酸比值显著降低（P〈0．05）；血清必需氨基酸中色氨酸、缬氨酸、苏氨酸浓度显著降低（P〈0．05）。甘氨酸与红细胞压积、丝氨酸／甘氨酸比值与红细胞压积和血红蛋白值呈显著正相关，半胱氨酸、缬氨酸和缬氨酸／甘氨酸比值与白蛋白（ALB）呈显著正相关。进一步将ALB按ALB〉30g／L、20g／L≤ALB≤30g／L、ALB〈20g／L分层分析，结果显示3组间缬氨酸浓度差异具有显著性（P=0．029）。酪氨酸、脯氨酸、甘氨酸、缬氨酸与转铁蛋白呈显著正相关（P=0．007，P=0．046，P=0．008，P=0．009）。结论ESRD患者血清游离氨基酸代谢与正常人相比，差异具有显著性；必需氨基酸普遍下降；非必需氨基酸高低不一。部分氨基酸的代谢可能影响患者白蛋白、血红蛋白和转铁蛋白的合成。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

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.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

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.