广州市棉尘病的研究

对广州市１９８９年仅有的两家加工纯棉工厂１３２０名工人作研究，发现可吸入性棉尘与总尘浓度、内毒素含量中位数分别为０．７１（０．４１－１．５１）与５．２８（３．０４－１２．３２）ｍｇ／ｍ＾３，２００７（１２３６－４１００）Ｅｕ／ｍ＾３；呼吸系统异常的检出率、慢性气管炎及棉尘病患病率分别为：（１）典型星期一症状９．０％，（２）班后ＦＥＶ１下降≥５％为１６．８％，（３）班后ＦＥＶ１下降≥１０％为４．２％     

Respiratory disease in a textile factory in Nicaragua

This is the first epidemiologic study conducted in a textile mill in Nicaragua using techniques and diagnostic criteria similar to those used in the United States and England. The prevalence of byssinosis and nonspecific respiratory symptoms were studied in 194 workers in a cotton mill in Managua. Limited environmental sampling, performed using a vertical elutriator in yarn preparation and weaving areas, indicated that exposures were similar to those reported in other parts of the developing world. A modified translated version of the Medical Research Council respiratory questionnaire was administered. Pulmonary function tests were performed before and after the Monday workshift to measure across-shift change in ventilatory function. The prevalence of byssinosis was 5.9% and all the cases occurred among exposed women. Nonspecific respiratory symptoms were also more prevalent among exposed workers. After adjusting for age, gender, smoking habit, and work tenure, the exposure odds ratios for usual cough and usual phlegm were 3.3 and 2.2, respectively. The association between exposure and across-shift decrement in FEV1 was not significant. Byssinotic workers, however, had greater decrements in FEV1% than those without byssinosis: 5.5% versus 1.8%. A consistent gender effect was observed in which both exposed and unexposed women were found to have greater across-shift decrements in FEV1 than men. The gender difference existed among long-term workers as well as workers who had been employed less than 2 years. Results are related to cotton dust exposure, as has been documented elsewhere. The poorer health status of the women in this study population deserves follow-up.     

Smoking Habits and the Leukocyte Count

In 86,488 multiphasic examinations, mean leukocyte counts were highest in cigarette smokers, intermediate in ex-cigarette and cigar or pipe smokers, and lowest in nonsmokers. Among the races, whites had the highest, yellows next, and blacks the lowest leukocyte counts. The leukocyte count was related to quantity smoked, inhalation, and smoking duration. Most groups who changed smoking habits showed corresponding changes in leukocyte counts. Higher leukocyte counts in smokers appeared largely to be a direct effect of smoking, although a small part of the increase seemed attributable to chronic bronchitis. A contribution of genetic or constitutional differences between smokers and nonsmokers was not ruled out. “Normal” leukocyte count values should take into account age, sex, race, and smoking status.     

An environmental and medical study of byssinosis and other respiratory conditions in the cotton textile industry in Egypt

This study was conducted in a typical Egyptian textile plant located in Alexandria. Male workers from all operations (N = 506) were examined and their dust exposures were assessed. Results showed that airborne dust concentrations were very high and that the plant fraction is mostly concentrated in respirable dust. Byssinosis prevailed in 21% of workers in opening and cleaning sections and in 13% in carding and combing rooms, but was found in none of the workers in drawing, twisting, and spinning operations, in only 1.1% in weaving, and in 3.1% of workers in other “auxiliary” occupations. The rare prevalence of byssinosis among the latter workers' groups was attributed to the workers' continuous exposure without fixed weekend interruption, the personal and family history of exposure to cotton, the low proportion of plant materials in dust evolved in related operations, the fine quality of Egyptian cotton, and/or the population characteristics of Egyptian workers. Reduction in FEV_1.0 at the end of the first work shift after absence from work occured more often than byssinosis, which indicates the importance of this test for the early detection of effects of cotton dust exposure. It is suggested that a nationwide study in the cotton textile industry is indicated.     

Chronic Lung Function Decline in Cotton Textile Workers: Roles of Historical and Recent Exposures to Endotoxin

Background

Long-term occupational exposure to cotton dust that contains endotoxin is associated with chronic respiratory symptoms and excessive decline in forced expiratory volume in 1 sec (FEV₁), but the mechanisms of endotoxin-related chronic airflow obstruction remain unclear.

Objective

In the current study, we examined temporal aspects of the exposure–response relationship between airborne endotoxin exposure, longitudinal change in FEV₁, and respiratory symptoms in a cohort of Chinese cotton textile workers.

Methods

This prospective cohort study followed 447 cotton textile workers from 1981 to 2006.at approximately 5-year intervals. We used a generalized estimating equations approach to model FEV₁ level and respiratory symptoms as a function of past exposure (cumulative exposure up to the start of the most recent 5-year survey interval) and cumulative exposure (within the most recent interval) to endotoxins, after adjusting for other covariates. Models were stratified by active versus retired work status and by years employed before the baseline survey (< 5 and ≥ 5 years).

Results and conclusions

Past exposure to endotoxin was associated with reduced FEV₁ level among retired cotton workers. Among all cotton workers, past exposure was more strongly associated with reduced FEV₁ for those hired < 5 years before baseline than for those who were hired ≥ 5 years after baseline. Recent endotoxin exposure was significantly associated with byssinosis, chronic bronchitis, and chronic cough.     

Medical and industrial hygiene characterization of the cotton waste utilization industry

We studied 260 workers in the cotton waste utilization industry and 310 "blue-collar" control workers from nondusty industries in the same geographic area of the United States by respiratory symptom questionnaire and by pre- and postshift spirometry. We excluded 75 cotton workers and 75 control workers from statistical analysis because of prior hazardous occupational exposures. Plant-wide, 8-hour time-weighted average exposures ranged from 0.28 mg/m3 to 7.80 mg/m3. The overall prevalence of symptoms compatible with byssinosis was 5.9% in cotton workers and 4.7% in the controls. Cotton workers with less than 2 years of employment had a significantly greater prevalence of bronchitis than their control counterparts. The cotton workers with 2 years or more of employment had significantly greater prevalences of bronchitis, shift decrement in forced expiratory volume in 1 second (FEV1) of greater than or equal to 10%, and FEV1/FEV1-predicted less than 80%, than their control counterparts. Regression analysis showed that for matched cotton and control workers, the percentage decrement in FEV1 over the shift was significantly greater for cotton workers; and that in all cotton workers, longevity in industry had a negative effect on the before-shift forced vital capacity (FVC). This study suggests that there are both acute and chronic effects of cotton exposure in the cotton waste utilization industry.     

Historical perspective on asbestos: policies and protective measures in World War II shipbuilding

Current public health consequences of poorly controlled utilization of asbestos in the past can be traced back, in part, to decisions made 45 or more years ago. This paper focuses on the extensive use of asbestos as a fireproofing and insulating material in shipbuilding in the 1940s, when World War II industrial expansion brought about a hitherto unprecedented rise in the amount of asbestos utilized. Twenty years after World War II, asbestos diseases began to manifest themselves, affecting thousands of shipyard workers as well as other workers who had been exposed in the 1940s and during the postwar period. By scrutinizing past actions, the paper argues that social forces, as well as science and technology, affect the setting of priorities and the determination of policy regarding needed but hazardous materials.     

Discovery in medicine—chance or science? the case of woodworkers' nasal cancer

The relative roles of chance and scientific observation in medical discovery are discussed. The emergence of ethmoidal adenocarcinoma as an industrial disease among makers of wooden furniture in an English area is related. Regular monitoring clinics held in the factories are then justified.     

Follow-up study of respiratory health of newly-hired female cotton textile workers

BACKGROUND: Numerous studies have investigated adverse effects of exposure to cotton dust on respiratory health, but very limited longitudinal data are available with regard to the early pulmonary response to cotton dust. Moreover, the adverse effects of occupational exposure to cotton dust have been difficult to separate from the confounding effects of smoking. This setting provided a unique opportunity to evaluate early respiratory effects in newly hired and non-smoking female textile workers. METHODS: To identify early pulmonary responses to cotton dust exposure and associated gram-negative bacterial endotoxin, respiratory symptoms and pulmonary function in 225 newly-hired textile workers were assessed at work initiation, and at three and twelve months later. RESULTS: All the workers were females and nonsmokers, with an average age of 18 years. Symptom incidence at three months was 3.6% for usual cough with phlegm, and 6.7% for usual dry cough. Lung function changes were detectable at one year: FEV1 declined by 70 ml and FVC by 124 ml over the year, and workers reporting respiratory symptoms at three months showed a significantly greater cross-shift drop in FEV1 (- 2.3%) than those without the symptoms (- 0.7%). CONCLUSIONS: These results suggest that the occurrence of respiratory symptoms represents the earliest response to cotton dust exposure, followed by lung function changes. Early respiratory symptoms may be a risk factor for subsequent loss of pulmonary function in cotton textile workers.     

Action on the social determinants of health: A historical perspective

Abstract

A renewed concern with social factors has emerged in global public health, spearheaded by the World Health Organization's Commission on Social Determinants of Health. The coming decade may see significant health gains for disadvantaged populations if policies tackle the social roots of health inequities. To improve chances of success, global action on social determinants must draw lessons from history. This article reviews milestones in public health action on social determinants over the past 50 years. The goal is to bring into sharper focus the persistent challenges faced by social determinants agendas, along with distinctive opportunities now emerging. The historical record highlights the vulnerability of health policy approaches incorporating social determinants to resistance from entrenched interests. The Commission on Social Determinants of Health can consolidate political support by building collaborative relationships with policymakers in partner countries. However, this strategy must be complemented by engaging civil society constituencies. Historically, successful action on social determinants has been spurred by organized civil society demand.     

Nutrition and Infection Field Study in Guatemalan Villages, 1959–1964

Triehloroethylene (TCE) postexposure breath decay curves were obtained from ten male and ten female volunteers who were exposed daily in a controlled-environment chamber to TCE vapor, 20, 100, or 200 ppm for one, three, or 71/2 hours. Alveolar breath samples were collected in glass pipettes for TCE analysis by gas chromatography.

The series of TCE breath decay curves obtained was highly reproducible and the narrow range of TCE in the breath at a specific time in the early postexposure period of persons identically exposed indicated that breath analysis could be used as a rapid method with which to estimate the magnitude of recent TCE exposure.

The TCE breath concentration in the immediate postexposure period accurately reflected the vapor concentration to which the subject had been most recently exposed. Breath samples collected eight to 24 hours following exposure were accurate indicators of the time-weighted average vapor exposure experienced by the subject on the previous day.     

An engineer's perspective of the intervention research workshop

As an engineer practicing in the area of engineering controls for the reduction of occupational exposures to hazardous agents, the Intervention Research Workshop studies appeared to be effective for the studied situations, yet the models may not be applicable across a wide range of intervention possibilities. A more generic model might be more appropriate, perhaps a business model. Dr. W. Edwards Deming has proposed a model for the production of goods and services. If we can view interventions as products which need to be sold to potential customers, perhaps this type of model would be more effective across a wide range of intervention strategies. © 1996 Wiley-Liss, Inc.

1 This article is a US Government work and, as such, is in the public domain in the United States of America.

     

Physiological Approach to Evaluation of Physical Capacity

Studies aimed at linking pollutant burdens to biological response and environmental exposure have yielded interesting preliminary results. Whereas easily collected specimens such as hair and blood have proven utility in estimation of environmental exposure, these tissues cannot, as yet, be considered a good quantitative indicator of many body pollutant burdens. Studies of occupationally exposed groups or groups of individuals with clinically evident disease have failed to clearly implicate pollutant burdens with either disease production or aggravation although, in general, the blood levels of these individuals do reflect increased exposure to pollutants. Studies of multiple tissue sets collected at autopsy are encouraging inasmuch as it appears these tissues will provide useful information about the pollutant burden for constructing predictive models and, in addition, provide flashback capabilities.