佛山市三水区2015年接触重点职业病危害因素工人健康监护结果分析

目的 掌握佛山市三水区接触职业病危害因素工人的健康状况。
方法 将三水区辖区内2015年81家重点监控企业2 961名接触粉尘、噪声、苯、铅的作业工人作为职业健康监护对象, 对其检查结果进行统计分析。
结果 共受检2 961名工人, 受检率为76.51%(2 961/3 870)。检出疑似职业病者20例, 检出率0.68%;其中疑似噪声聋者18例, 疑似慢性苯中毒者2例; 粉尘和铅作业工人均未发现疑似职业病者。职业禁忌证检出率2.30%(68/2 961);其中粉尘作业禁忌证检出率2.40%(12/500), 噪声作业禁忌证检出率2.32%(54/2 336), 苯作业禁忌证检出率1.95%(2/103), 铅作业未发现职业禁忌证者。不同职业病危害因素接触工人、不同规模企业工人、不同经济类型工人、不同风险类别企业工人受检率比较, 差异均有统计学意义(P < 0.05), 其中尤其以大型企业、私有企业和风险类别严重企业工人的受检率为低。不同规模企业的作业工人疑似职业病检出率差异有统计学意义(P < 0.05), 以大型企业为最高; 不同经济类型企业的作业工人职业禁忌证检出率差异有统计学意义(P < 0.05), 以国有企业为最高。
结论 佛山市三水区应改善接触职业病危害因素工人的监护工作, 将职业健康监护重点放在大型企业以及存在噪声和苯系物等重要职业病危害因素的企业。
     

Identificazione dei lavoratori ex-esposti ad amianto in Toscana da inserire nel programma di sorveglianza sanitaria

«Identification of workers with past asbestos exposure in Tuscany eligible to health surveillance programme».Background:In 2016 the Administration of the Tuscany Region, Italy, established a health surveillance programme for workers with past asbestos exposure. The programme includes two levels of activities, a local basic health evaluation, and a centralized in-depth evaluation of specific cases.Objectives:To estimate the number and identify the workers with past exposure to asbestos in Tuscan industrial settings entitled to participate in the health surveillance programme.Methods:The number of formerly-exposed workers was estimated from the records of the working population of 15,441 workers of thirteen Tuscan asbestos industrial plants and from the existing data bases of the Local Health Administrations (USLs) and the Institute for Study, Prevention and Cancer Network (ISPRO), and from national data bases such as Social Security Administration (INPS) and National Institute for Insurance against Accidents at Work (INAIL). The expected number of medical examinations per year was estimated from the adhesion rates seen in previous comparable programmes.Results:The estimated number of workers with past asbestos exposure eligible to the programme was 5,446. The estimated number of health examinations in the first and second phases of the surveillance programme during 2016-24 was 7,275 and 7,155, respectively, follow-up examinations included. The number of workers identified from local data bases was 4,713: They had been operating in 129 plants that had been using asbestos in the past. Further 1,395 workers were identified from previous health surveillance activities.Conclusions:The use of several sources of information and the cooperation between occupational health services made it possible to identify a high proportion of former asbestos workers and plants., It is, nevertheless, still necessary to complete the list of eligible workers, and to facilitate their participation by making the programme more widely known.Key words: Past occupational exposure, health surveillance, asbestos     

Surveillance and prevention of work-related carpal tunnel syndrome: An application of the sentinel events notification system for occupational risks

In response to limitations in state-based, occupational disease surveillance, the California Department of Health Services developed a model for provider- and case-based surveillance of work-related carpal tunnel syndrome. The objectives were to enhance case reporting, identify risk factors and high-risk work sites, and link preventive interventions to work sites and the broader community. Using elements from surveillance of communicable diseases and sentinel health events, a model was integrated into the pre-existing reporting system in one California county. Between 1989 and 1991, 54 Santa Clara County health care providers reported 382 suspected cases, of which 365 from 195 work sites met reporting guidelines. Risk factors were profiled from interviews of 135 prioritized cases and 38 employers. Of 24 work sites prioritized for a free, voluntary, nonenforcement inspection, 18 refused and 6 completed an on-site visit. Sentinel Event Notification System for Occupational Risks (SENSOR) captured many cases not reported to the pre-existing reporting system. Case interviews indicated a profile of symptoms and signs, treatment, and exposure to uncontrolled occupational risk factors, including a lack of training on ergonomics hazards. Employer health insurance, rather than workers' compensation, was the apparent source of payment for most medical bills. Employers lacked knowledge and motivation to reduce ergonomic risks. Governmentally mandated occupational ergonomics standards are urgently needed.     

Occupational health in Brazil

Brazil is a recently industrialised country with marked contrasts in social and economic development. The availability of public/private services in its different regions also varies. Health indicators follow these trends. Occupational health is a vast new field, as in other developing countries. Occupational medicine is a required subject in graduation courses for physicians. Specialisation courses for university graduated professionals have more than 700 hours of lectures and train occupational health physicians, safety engineers and nursing staff. At the technical level, there are courses with up to 1300 hours for the training of safety inspectors. Until 1986 about 19 000 occupational health physicians, 18 000 safety engineers and 51 000 safety inspectors had been officially registered. Although in its infancy, postgraduation has attracted professionals at university level, through residence programmes as well as masters and doctors degrees, whereby at least a hundred good-quality research studies have been produced so far. Occupational health activities are controlled by law. Undertakings with higher risks and larger number of employees are required to hire specialised technical staff. In 1995 the Ministry of Labour demanded programmes of medical control of occupational health (PCMSO) for every worker as well as a programme of prevention of environmental hazards (PPRA). This was considered as a positive measure for the improvement of working conditions and health at work. Physicians specialising in occupational medicine are the professionals more often hired by the enterprises. Reference centres (CRSTs) for workers' health are connected to the State or City Health Secretariat primary health care units. They exist in more populated areas and are accepted by workers as the best way to accomplish the diagnosis of occupational diseases. There is important participation by the trade unions in the management of these reference centres. For 30 years now employers organisations have also kept specialised services for safety and occupational health. Although they are better equipped they are less well used by the workers than the CRSTs. At the federal level, activities concerned with occupational health are connected to three ministries: Labour, Health and Social Security. The Ministry of Labour enacts legislation on hygiene, safety and occupational medicine, performs inspections through its regional units and runs a number of research projects. The Ministry of Health provides medical care for workers injured or affected by occupational diseases and also has surveillance programmes for certain occupational diseases. The Ministry of Social Security provides rehabilitation and compensation for registered workers. In spite of a decrease in the number of accidents at work during the past 25 years, working conditions have not improved. Changes in the laws of social security in the 1970s discouraged registration and reporting of occupational injuries and diseases. In consequence death rates due to accidents increased. With the implementation of the CRSTs, the recorded incidence of occupational diseases has risen, not only because of improved diagnosis, but also because of stronger pressure from the unions and better organisation of public services and enterprises. Received: 24 February 1997 / Accepted: 14 March 1997     

Intervention strategies directed at exposure to organic solvents at worksites: A case study

Exposure to organic solvents is a serious occupational health problem. Research has mainly been focused on the harmful medical effects of the substances. Models for practical safety work are lacking. The purpose of this review is to summarize and scrutinize experience gained by implementing methods for early detection of symptoms caused by exposure to solvents in the health services and practical safety work in the wood processing industry. Five interdependent phases have been developed during a 10-year period within the framework of a multidisciplinary collaboration: i) community diagnosis, ii) a treatment program, iii) an occupational environment program, iv) education and v) a demonstration plant. The results illustrate the need for regional epidemiological surveillance and increased collaboration between the health services and other sectors of the community.     

Reported occupational respiratory diseases in Catalonia

Objectives

A voluntary surveillance system was implemented in Catalonia (Spain) to ascertain the feasibility, incidence, and characteristics of occupational respiratory diseases and compare them with those of the compulsory official system.

Methods

In 2002, in collaboration with the Occupational and Thoracic Societies of Catalonia, occupational and chest physicians and other specialists were invited to report, on a bimonthly basis, newly diagnosed cases of occupational respiratory diseases. Information requested on each case included diagnosis, age, sex, place of residence, occupation, suspected agent, and physician''s opinion on the likelihood that the condition was work related. Compulsory official system data derived from statistics on work related diseases for possible disability benefits declared by insurance companies, which are responsible for declaring these diseases to the Autonomous Government of Catalonia.

Results

Of 142 physicians seeing patients with occupational respiratory diseases approached, 102 (74%) participated. Three hundred and fifty nine cases were reported, of which asthma (48.5%), asbestos related diseases (14.5%), and acute inhalations (12.8%) were the most common. Physicians rated 63% of suspected cases as highly likely, 28% as likely, and 8% as low likelihood. The most frequent suspected agents reported for asthma were isocyanates (15.5%), persulphates (12.1%), and cleaning products (8.6%). Mesothelioma (5.9%) was the most frequent diagnosis among asbestos related diseases. The number of acute inhalations reported was high, with metal industries (26%), cleaning services (22%), and chemical industries (13%) being the most frequently involved. The frequency of occupational respiratory diseases recorded by this voluntary surveillance system was four times higher than that reported by the compulsory official system.

Conclusions

The compulsory scheme for reporting occupational lung diseases is seriously underreporting in Catalonia. A surveillance programme based on voluntary reporting by physicians may provide better understanding of the incidence and characteristics of these diseases. Persulphates and cleaning products, besides isocyanates, were the most reported causes of occupational asthma. Metal industries and cleaning services were the occupations most frequently involved in acute inhalations with a remarkably high incidence in our register.     

广州市职业健康监护和职业病发病状况分析

目的分析广州市职业健康监护工作和职业病发病的特点。方法对1993至2002年全市劳动卫生工作情况汇总资料进行职业健康监护和职业病发病状况的回顾性研究。职业健康监护体检资料按时间顺序每5年分一组，共分两组，即1993至1997年为第1组，1998至2002年为第2组。结果10年职业健康监护体检年平均受检率均在75％以上。第2组噪声听力损伤、观察对象、物理因素重点监护人员和粉尘、化学因素禁忌证人员明显高于第1组，差异有统计学意义（P〈0．01）。第1组新发慢性职业病共91例，第2组181例，两组发病率的差异有统计学意义（P〈0．05），其中化学中毒和噪声听力损伤的发病率上升明显，两组尘肺的发病率差异无统计学意义（P〉0．05）。10年共发生各类职业病581例，其中急性中毒309例，占53．18％，慢性职业病272例，占46．82％；慢性职业病中尘肺占16．70％，铅和苯化学中毒占16．87％。随着时间的推移，尘肺、化学因素中毒和总职业病患者发病工龄趋于年轻化，发病工龄也明显缩短，差异均有统计学意义（均P〈0．01）。结论广州市初步建立了一个较规范的职业健康监护体系。体检中检出的噪声职业性重点监护和粉尘、化学因素禁忌证人员明显上升；职业病发病明显上升，以急性职业中毒和尘肺、铅和苯中毒为主；慢性职业病患者发病年龄趋于年轻化，发病工龄缩短。     

Priorities in occupational health research: a Delphi study in The Netherlands.

OBJECTIVES: To achieve a coherent programme of topics for research in occupational health and safety, with well founded priorities and to relate them to perceived gaps and needs in The Netherlands. METHODS: In the first phase of the study 33 key informants were interviewed. In the second phase questionnaires were sent to 150 Dutch experts (including the key informants). Four groups were recruited, originating from: occupational health and safety services; scientific research institutes; governmental and other administrative bodies; and companies. Using the Delphi technique, the experts were asked to prioritize several topics, which were placed under different headings. In the third phase five workshops were organised to elaborate on the highly prioritized topics. RESULTS: The response rates were 86% for the first and 81% for the second questionnaire. In the second round consistency was reached and consensus proved to be satisfactory; so that the Delphi process was stopped. There were surprisingly few differences in opinion between the four groups. The most important heading was "design/implementation/evaluation of measures", in which the topic cost-benefit analysis of measures had the highest score. "Assessment of relations between exposure and effect" was the second most important heading. Under this heading, topics on work stress were generally judged to be more important than topics on safety and biological, chemical, and physical hazards. The headings "occupational rehabilitation/sociomedical guidance" and "occupational health care/occupational health services" had about the sam priority, closely following the heading "assessment of relations between exposure and effect". CONCLUSIONS: The general agreement on priorities should provide a sufficiently broad basis for decision makers to initiate a long term programme for occupational health research and development in The Netherlands.     

Victoria M. Trasko: champion of state-based surveillance of occupational diseases in the United States, 1937 to 1971.

Victoria M. Trasko (1907-1979), a relatively unknown figure to many currently practicing occupational health specialists, was a pioneer in state-based surveillance of occupational diseases in the United States. To highlight her accomplishments during her career with the United States Public Health Service from 1937 to 1971, this report briefly reviews her publications on occupational disease surveillance. Her span of work includes guidelines for state industrial hygiene programs, numbers of workers in state occupational health programs, compilation of state and local laws related to industrial hygiene, proposals for standardized reporting of occupational disease, and analysis of trends in workers' compensation and mortality statistics for occupational diseases. She pilot tested the first state-based model system for occupational disease reporting in the United States. She documented the great difficulty experienced by states in getting physicians to report cases of occupational diseases, and pointed out that surveillance of other existing data sources was worthwhile, at least for some occupational diseases. She was the first to report on the distribution of silicosis cases in the United States by state, industry, and job title. She was the first to comment on mortality trends for the pneumoconioses and to document problems in comparability between different International Classification of Disease (ICD) periods.     

Disease Management as a Part of Total Health and Productivity Management

When adults become ill they typically use more than just medical care services. They often miss time from work or incur periods of short term disability. In some cases, they also use workers’ compensation, occupational health or long term disability programme services and, in some situations, sick employees may attend work but be substantially less productive. Disease management programme vendors can enhance their services by managing the full spectrum of health and productivity programme services that people use, not just medical care services.Health and productivity management (HPM) refers to the coordination of the many types of services that employees use. These services include medical care, disability programmes, workers compensation programmes, employee assistance programmes, absenteeism and occupational safety programmes. HPM also refers to activities meant to enhance on-the-job productivity. HPM requires that disease management programme managers take a broader view of health and disease management than is typical. These programme activities may include deciding which disease(s) to address as priorities; developing treatment guidelines that focus on more than just clinical care; choosing appropriate and relevant outcome measures to address; implementing interventions that enhance productivity, improve health, and limit unnecessary medical care use; and supporting continuous quality improvement efforts.Considering these activities under an HPM umbrella requires a focus on productivity and quality of life that will add substantial value to the services offered by disease management programmes. The HPM approach will be more costly initially, but should prove more cost effective in the long term, since it considers a much wider array of potential benefits from health and disease management.     

昆明铁路局2009年职业健康监护结果分析

目的对昆明铁路局职业病危害作业人员健康监护状况进行分析,为制定有效的干预措施和防制职业病提供依据。方法使用描述性流行病学研究方法对昆明铁路局2009年职业病危害因素监测结果和作业人员健康监护结果进行统计和分析。结果昆明铁路局职业病危害监测合格率为:粉尘84.09%,毒物92.86%,噪声48.72%,其他物理因素(手传振动、工频电场、高温)100%。职业病危害作业人员受监护率97.44%;异常检出率为:高频听力损失5.37%,胸片异常0.11%,心电图异常6.52%,血压异常1.19%,实验室检查:血常规异常3.10%,尿常规异常3.42%;职业禁忌证4人。结论粉尘、噪声是昆明铁路局主要的职业病危害因素,在进行职业病综合防治的同时还应重视职业安全教育并积极开展健康促进活动。     

The surveillance of work-related pesticide illness: an application of the Sentinel Event Notification System for Occupational Risks (SENSOR)

OBJECTIVES. In response to limitations in state-based occupational disease surveillance, the California Department of Health Services developed a model for surveillance of acute, work-related pesticide illness. The objectives were to enhance case reporting and link case reports to preventive interventions. METHODS. Elements from surveillance of communicable diseases and sentinel health events were used to integrate a model into the preexisting system in one agricultural country. RESULTS. Between 1988 and 1991, 45 Fresno County health care providers reported 230 suspected cases, of which 217 from 80 work sites met reporting guidelines. Risk factors were profiled from interviews of 81 prioritized case patients and 36 employers. Fifteen work sites were visited and 117 recommendations were made, of which 6% were identified in enforcement inspections. Pest management experts consulted with growers on reducing future pesticide use. CONCLUSIONS. Risk factors for pesticide illness were prevalent. Agricultural inspectors did not detect routine and serious hazards. Integrated pest management should be expanded and linked to occupational health. Agricultural enforcement personnel should be oriented and trained in occupational safety and health.     

厦门市有毒有害作业工人职业健康监护分析

目的分析厦门市职业健康监护工作和职业病发病的特点,为厦门市职业病防治决策提供依据。方法对该市2006—2009年职业健康监护和职业病发病状况进行描述性研究。①分析厦门市不同行业、规模、危害因素的健康监护资料。②分析2006—2009年受检率变化和职业病构成,同时分析尘肺的发病状况。结果①2009年厦门总接触率14.08%;受检率88.88%。不同规模企业受检率有统计学意义(P0.05)。粉尘是主要危害因素,职业病以尘肺为主。②4年职业健康监护年平均受检率达到75%以上。2006—2007年为第1组,2008—2009年为第2组。第2组化学重点监护、疑似职业病检出率和物理疑似职业病检出率明显高于第1组(P0.01、P0.05、P0.01),粉尘和物理重点监护检出率明显低于第1组(P0.05)。尘肺诊断年龄趋于年轻,主要工种为电焊工。结论厦门市初步建立了较规范的职业健康监护体系。粉尘是主要危害因素,职业病以尘肺为主,今后工作重点应针对粉尘作业工人加强职业健康监护,同时用人单位应建立健全职业病防治管理机制,卫生部门应加大对企业的职业卫生监管力度。     

噪声作业对心血管系统的影响

目的探讨职业性噪声对工人心血管系统的影响及其影响因素。方法采用断面流行病学方法，对17家工厂1906名工人（噪声接触953例，对照组953例）进行调查研究，用问卷调查、作业环境监测、健康检查资料分析职业性噪声对工人心血关系统的影响。结果噪声接触组的心电图异常率为16．7％，明显高于对照组的9．8％。噪声接触组的高血压患病率为11．9％，明显高于对照组的7．5％，经X^2检验，差异有统计学意义（P〈0．05），年龄分层分析中，低于50岁3组，差异有统计学意义，而高于50岁组，差异无统计学意义（P〉0．05）。结论职业性噪声接触可能是心血管疾病的危险因素，年龄是研究偏倚的重要影响因素。     

信息化在职业健康监护质量控制中的应用

针对职业健康监护工作存在的问题,通过建立信息管理系统和职业病防治信息平台,对职业健康监护的关键环节进行质量控制,对职业健康监护信息进行共享,实现了职业健康监护工作的程序化、规范化、信息化和现代化,提高了职业健康监护工作的质量。     

Results of a health education program on smoking for trainee workers

BACKGROUND: Social costs of smoking behaviour are remarkable. Although smoking is an individual choice, it is strongly influenced by a social contest where it is widespread. OBJECTIVES: To induce young non-smoking apprentices to continue as such and smokers to give up smoking. METHODS: During 1999, a specific health education programme on smoking was carried out for a group of 1083 young apprentices, 531 females and 552 males, who came to the occupational health unit in Venice for a check on work fitness. This programme was part of a larger global programme concerning health hazards prevention where apprentices received various information about health and safety at work. Smoking habits were compared to a control group of 312 females and 458 males after a one year follow-up. RESULTS: The females' chance of giving up smoking was three times higher than controls; while the chance of becoming a smoker was 70% lower. The males' chance of giving up smoking was double; while the chance of becoming a smoker was 60% lower. The health education programme decreased the trend of becoming a smoker in cases and increased non-smoking, especially in females. In females, there was also a significant prevalence who reduced cigarette consumption. CONCLUSIONS: This study demonstrates the effectiveness of health education programmes on smoking directed to young people and stresses the role of public health units in the involvement of the users of such services in prevention programmes. An occupational health service has specific prevention objectives here, since promoting healthy attitudes affects motivation of individual behaviour. This is the reason why initiatives on a single specific prevention objective, like smoking, become significant in every context of people's lives. Such attitudes are a significant resource which people can use to protect themselves from hazards, with a resulting safe, aware and active behaviour as regards occupational risks.     

Acute occupational respiratory diseases in hospital discharge data

We investigated the feasibility of using hospital discharge diagnoses of ICD codes 506, 507, and 508, respiratory diseases from external sources, to identify occupational sentinel health events [SHE(O)]. Two hundred sixty-nine records were reviewed and 66 (25%) were incidents where the work-relatedness of the respiratory diseases was documented in the medical records. Twenty-six percent of the 269 records contained no exposure information. Sixty-four of the 66 occupational cases were from ICD codes 506.0-506.9, with the largest number classified as ICD codes 506.0 (bronchitis and pneumonitis due to fumes and vapors) and 506.3 (other acute and subacute respiratory conditions due to fumes and vapors). We conclude that surveillance of ICD codes in the 506 series, where 39% of the cases were secondary to occupational exposures, is a valuable component of a surveillance system for preventable occupational lung disease.     

Occupational health in the Negev: a model for regional planning

In the Negev region of Israel, I tested a model approach to occupational health planning. This model included components assessing exposures, measuring adverse health outcomes, and evaluating health services. I analyzed employment survey data, compiled an exposure data base, and carried out site visits covering 10,707 employees (over 50% of the regional industrial work force). Site visits identified exposure hazards of inorganic and organic dusts, heavy metals, chemicals, pesticides, and noise. I identified elevated relative regional injury rates by Standard Morbidity Ratios (SMRs) in a variety of industries, including sixfold increases for mining and non-metallic minerals manufacture (SMR 6.8, 99% CI 6.1-7.7). Review of biological monitoring data suggested deficiencies in pesticide and heavy metals surveillance. A survey of primary care clinics estimated 13,707 cases of occupational injury and illness untreated by existing occupational medical services. Based on these findings, I formulated regional occupational health planning goals, including targeting high-risk industries for increased preventive activities. This regional approach, combining multiple measures of occupational health status, can serve as a model for assessing local public health planning needs.     

Two cases of pleural mesothelioma following unusual and unrecognized exposure to asbestos. The role of Occupational Health and Safety Service in identifying past occupational exposure

BACKGROUND: In Italy there was a wide use of asbestos in various manufacturing sectors and for many different uses, some of which are still partly or completely unknown. A detailed reconstruction of the work histories of mesothelioma patients made it possible, in some cases, to identify ignored circumstances of asbestos exposure. Moreover, the identification of cluster of cases takes on special significance in suggesting a possible previous asbestos exposure, where the information collected on single cases do not imply as much. OBJECTIVES: This report concerns two cases of malignant mesothelioma that occurred in two workers employed in the same processes in a small factory that manufactured and repaired electric motors for hand tools. METHODS AND RESULTS: In the Province of Brescia (one million inhabitants) a Mesothelioma Register is in operation. The first case was classified, according to Re.Na.M.1996 criteria (National Mesothelioma Register) as "unknown" occupational exposure. The identification of a second case, that was discovered thanks to the surveillance system of the Mesothelioma Register, encouraged the local Occupational Health and Safety Service to perform a more detailed investigation that revealed, for both subjects, previously unknown occupational exposure. This consisted of grinding, in a damp setting, electric motor parts bushed with phenolic thermosetting resins reinforced with chrysotile asbestos. Moreover, weekly cleaning of the plants could have been an occasion for dust dispersion. It is likely that this exposure did not last long and was limited in extent. Other similar reports of such circumstances of occupational exposure were not available in the literature. CONCLUSIONS: The results confirm the high information value of systematic collection of incidental cases in the population, which is feasible thanks to the disease register, and the significant role of the local Occupational Health Services in demonstrating past asbestos exposure.     

职业健康监护网络管理系统的应用

目的应用简单、快捷、适用的职业健康检查网络系统,提高职业健康监护管理效率。方法采用Oracleqi数据库,将职业健康技术服务机构所有体检相关部门计算机联网,开发职业健康检查系统;并建立劳动者、用人单位及技术服务机构基本档案,生成职业健康监护各类报表,建立职业健康监护网络管理系统。结果经过4年多的开发与应用,实现了各部门体检数据网络传输,简化了体检流程,减少了重复劳动,提高了职业健康监护效率。结论该系统是简单、快捷、适用的职业健康监护管理系统,功能强大,具有很好的应用价值,适合地（市）级以上职业健康监护部门采用。