呼吸性矽尘与矽肺的暴露——反应关系

本文在某钨矿进行了呼吸性矽尘与矽肺的暴露～反应关系的研究。首先对该矿井下呼吸性粉尘与息扮尘浓度的关系进行了研究,把历史接尘资料中总粉尘浓度转换为呼吸性粉尘浓度。最后用Logistic多元回归模型对1151名工人的接尘资辩进行了处理,推算出在一定接尘条件下,呼吸性矽尘的容许浓度为0.24mg/m~3。     

Respirable Dust and Respirable Silica Exposure in Ontario Gold Mines

A comprehensive survey of respirable dust and respirable silica in Ontario gold mines was conducted by the Ontario Ministry of Labor during 1978–1979. The aim was to assess the feasibility of introducing gravimetric sampling to replace the assessment method which used konimeters, a device which gave results in terms of number of particles per cubic centimeter (ppcc) of air. The study involved both laboratory and field assessments. The field assessment involved measurement of airborne respirable dust and respirable silica at all eight operating gold mines of the time. This article describes the details of the field assessment. A total of 288 long-term (7–8 hr) personal respirable dust air samples were collected from seven occupational categories in eight gold mines. The respirable silica (α-quartz) was determined by x-ray diffraction method. The results show that during 1978–1979, the industry wide mean respirable dust was about 1 mg/m³, and the mean respirable silica was 0.08 mg/m^3.The mean% silica in respirable dust was 7.5%. The data set would be useful in future epidemiological and health studies, as well as in assessment of workers’ compensation claims for occupational diseases such as silicosis, chronic obstructive pulmonary disease (COPD), and autoimmune diseases such as renal disease and rheumatoid arthritis.     

红外光谱法与焦磷酸消化法测定粉尘中游离二氧化硅含量的比较

目的比较红外光谱法与焦磷酸消化法测定粉尘中游离二氧化硅的可行性。方法对粉尘中游离二氧化硅含量用上述2种方法分别进行测定,比较2种方法测定结果。结果红外光谱法与焦磷酸消化法测定游离二氧化硅含量值差异无统计学意义（P〉0.05）,游离二氧化硅含量在0～100.03 mg范围内与吸光度值有良好的线性关系,相关系数r=0.9996。样品加标回收率为93.08%～95.01%,测定结果的相对标准偏差不大于5.21%（n=5）。结论红外光谱法可以实现高精度快速批量检测,可以逐步取代焦磷酸消化法。     

X线衍射法与焦磷酸消化法测定粉尘中游离二氧化硅含量的比较

对粉尘中游离二氧化硅含量进行了Ｘ线衍射法和焦磷酸消化法的对比测定。结果表明,Ｘ线衍射法与焦磷酸地的结果之间有很好的相关性,其测定值在统计学上无显著性差异（Ｐ〉０．０５）,两方法测定值的相关回归方程是Ｙ＝１．０００９Ｘ＋２．２６２６,ｒ＝０．９７１９。Ｘ线衍射法的相对偏差小于１０％,达到常规微量（０．１～５ｍｇ）样本的分析要求;可以较好地排除某些干扰因子对结果的影响。     

Retrospective exposure assessment for respirable and inhalable dust, crystalline silica and arsenic in the former German uranium mines of SAG/SDAG Wismut

OBJECTIVES: Starting shortly after the reunification of Germany and lasting up to the end of the 1990s, an extensive series of retrospective exposure investigations for the East German uranium mining industry was performed in order to provide information about the exposure situation of the miners towards respirable dust, inhalable dust, crystalline silica and heavy metals. It should provide the necessary information for legal compensation of miners with potential industrial diseases as well as for epidemiological research. METHODS: Extensive side-by-side measurements using original historic equipments as well as comprehensive evaluation of the time increments of specific jobs with respect to exposure relevant tasks were performed. After attributing average exposures to the tasks, shift exposures for the jobs could be calculated. RESULTS: By the end a comprehensive job exposure matrix for all underground jobs of the German uranium mining industry was developed for the components mentioned, including arsenic where relevant. In the early days of SAG/SDAG Wismut dust and silica exposures were extremely high with respirable dust up to 20 mg/m(3) and respirable crystalline silica well above 2 mg/m(3) as shift averages. Beginning from about the early 1960s dust control measures started to improve conditions dramatically. CONCLUSIONS: It is absolutely necessary to invest sufficient effort for the estimation of exposure situations of past technological environments. Especially, the situation of early mechanised mining, characterised by low ventilation, dry drilling techniques and generally lacking dust control measures was characterized by extreme shift exposures. It is important to keep these in mind when metal mining exposure in different environments is considered.     

Exposure-response relationships for coal mine dust and obstructive lung disease following enactment of the Federal Coal Mine Health and Safety Act of 1969.

Underground U.S. coal miners were studied cross-sectionally for the association of respirable coal mine dust exposure with pulmonary function and symptoms of airways obstruction. The study group included 1,185 miners participating in Round 4 of the National Study of Coal Workers' Pneumoconiosis who had started mining in or after 1970 when comprehensive exposure regulations first came into effect. Quantitative estimates of cumulative exposure, derived using respirable dust measurements taken by the Mine Safety and Health Administration over the entire study period, were used in linear and logistic regression models on indicators of pulmonary function and chest symptoms while controlling for smoking status, pack-years, and other potential confounders. Statistically significant associations between log cumulative exposure and decrements in FVC, FEV1, and FEV1/FVC were observed. In logistic models, statistically significant associations of cumulative exposure with increasing prevalence of FEV1 and FEV1/FVC less than 80% predicted and symptoms including chronic phlegm, chronic bronchitis, breathlessness, wheeze, and wheeze with shortness of breath were found. It is concluded that exposures to respirable coal mine dust present in U.S. mines since 1970 continue to affect respiratory health in underground miners.     

The accuracy of self-reported regulatory data: the case of coal mine dust

Coal-mine owners are required to measure miner exposures to respirable dust so that compliance with Federal health regulations can be monitored. This study analyzes the problem of possible underreporting of dust exposures. Using two statistical approaches, data for three mining occupations in 54 large underground coal mines during 1976-1978 are examined for evidence of underreporting. First, regression estimates compare dust concentrations reported by coal-mine owners with those reported by government health inspectors. Then, the statistical distribution of concentrations reported by coal-mine owners are examined for the size and nature of their deviation from log-normality. Both approaches suggest widespread underreporting.     

The incidence and progression of pneumoconiosis over nine years in U.S. coal miners: I. Principal findings

Chest radiographs, taken at a 9-year interval for 1,261 U.S. coal miners, were read for pneumoconiosis side-by-side by six readers in a controlled trial. Incidence and progression of small, rounded opacities were consistent with levels predicted from dose-response curves developed by the British Pneumoconiosis Field Research interpolated at a concentration derived from U.S. compliance levels mandated over the last 9 years. The results imply that the level of pneumoconiosis in U.S. miners is being reduced through application of the current 2 mg/m3 standard. The long developmental period for pneumoconiosis necessitates that further study be undertaken to verify this finding and to determine whether 2 mg/m3 is an appropriate regulatory dust level for the prevention of category 2 or greater simple pneumoconiosis over a 35-year period.     

The incidence and progression of pneumoconiosis over nine years in U.S. coal miners: II. Relationship with dust exposure and other potential causative factors

Examination of the incidence and progression of pneumoconiosis over 9 years in 1,261 nationally distributed U.S. coal miners has been undertaken in relationship to potential causative factors. Use has been made of a large body of data on dust levels collected by the Mine Safety and Health Administration principally for compliance purposes. Reported dust levels were low and generally under the current 2 mg/m3 standard. No link between dust level and disease progression could be detected. Some evidence was seen that radiological change was related to dust exposures prior to the study in both coal and noncoal mines, and thus experienced before the current dust standards were mandated. Neither migration of miners nor mining method appeared to be associated with disease incidence or progression. None of these findings can be taken as final, as the period of study is short and the number of cases of pneumoconiosis few. Further study is under way to obtain more reliable information over a longer period of follow-up.     

Respiratory protection: associated factors and effectiveness of respirator use among underground coal miners

BACKGROUND: We investigated factors associated with the use of respiratory protection and explored the effectiveness of respirators among coal miners. METHODS: Between 1987 and 1992, respiratory symptoms, smoking, lung function, and dust exposures were assessed longitudinally among 185 underground bituminous coal miners. Self-reported use of respiratory protection was expressed as mean percent time wearing a respirator. RESULTS: Miners' respirator use increased with mean dust concentration, but decreased with tobacco consumption. Increasing age was associated with greater respirator use. Miners who had respiratory symptoms at the initial survey subsequently reported greater use of respirators. A significant protective association was found between the miners' respirator use and FEV(1) levels at both the initial and follow-up surveys. CONCLUSIONS: These results provide additional evidence that respirator use is protective of lung health. When respiratory protection programs are developed, factors that may affect respirator use behavior, such as age, smoking, and respiratory symptoms, should be considered. Future studies of respiratory health will need to consider workers' use of respiratory protection.     

The Decline and Imminent Fall of U.K. Governmental Occupational Health: A Tale of Forgotten Lessons and Missed Opportunities

Abstract

Governmental efforts to monitor and regulate occupational health and safety hazards in the United Kingdom have been seriously etiolated by recent developments emanating from the HSC and the HSE that gut already indequate strategies in ways that favor industry prerogatives over workers, and by governmental inattention.     

Effectiveness of an intervention campaign on influenza vaccination of professionals in nursing homes: A cluster-randomized controlled trial

Background

Seasonal influenza has a major individual and collective impact, especially among the elderly living in nursing homes. To prevent infection by influenza viruses, vaccination of residents and professionals is an essential measure. However, while the vaccination rates of residents are generally high (>85%), rates among professionals are generally approximately 20%. To evaluate the effectiveness of an intervention campaign on the improvement of the influenza vaccination rate of professionals, a regional intervention study was proposed for nursing homes during the 2014–15 season.

The mental and physical health of miners following the 1992 national pit closure programme: a cross sectional survey using General Health Questionnaire GHQ-12 and Short Form SF-36

Background: In the twelve months following the announcement of the UK pit closure programme in October 1992, 22 500 miners were made redundant. In 1994 we undertook a cross-sectional survey to determine whether the mental and physical health of men who had been employed in the Nottinghamshire mining industry differed from that of the general population.Methods: A postal questionnaire was designed incorporating the General Health Questionnaire (GHQ-12), and six domains from SF-36. Questionnaires were sent to 1064 miners and ex-miners and 2097 other men in Nottinghamshire. Non-responders were sent two reminders.Results: The final response rate was 51%. The percentage of responders with GHQ-12 scores of three or more (suggesting psychological disorder) was 46% for those still employed in the mining industry, 52% for unemployed former miners and 22% for working non-miners (odds ratios: 3.0 [95% C.I. 2.2–4.1] for current miners and 3.9 [95% C.I. 2.6–5.7] for unemployed miners compared with working non-miners). The miners and ex-miners also had lower scores (suggesting greater morbidity) for each of the SF-36 domains tested. When stratifying for age in respondents of social classes IIIM-V the scores of current miners were significantly lower than those of working non-miners (P < 0.01).Conclusions: This study suggests that when surveyed in 1994, men who had been employed in three Nottinghamshire collieries in 1992 were psychologically and physically disadvantaged compared with working non-miners. Whether these findings are a result of pit closures is uncertain. However, significant potential health needs have been demonstrated.     

The impact of the arts in healthcare on patients and service users: A critical review

This review provides an updated evaluation of the emerging body of literature on the value of the arts in healthcare settings. Internationally, there is growing interest in the use of the arts in the healthcare context supported by the number of research studies reported in the nursing and medical literature. There is evidence that arts interventions have positive effects on psychological and physiological outcomes on patients in a hospital environment. A critical review of the literature between 2011 and 2016 was undertaken. The following databases were searched: MedLine, CINAHL, AMED, Web of Science and ASSIA. Searches included words from three categories: cultural activities, outcomes and healthcare settings. Initial searches identified 131 potentially relevant articles. Following screening and review by the research team, a total of 69 studies were included in the final review. The majority of studies examined the effect of music listening on patients/service users (76.8%). These studies were primarily quantitative focusing on the measurable effects of music listening in a surgical context. Overall, the studies in the review support the growing evidence base on the value of the arts in a variety of healthcare settings for patients/service users. The review findings suggest that now is the time for different voices and art forms to be considered and represented in the research on arts in healthcare. Further research is also required to strengthen the existing evidence base.     

第二受害者的经验与支持调查:以某精神专科医院护士为例

目的调查患者安全事件中精神专科医院护士作为第二受害者的经验与支持现状,并分析影响因素。方法2020年9月便利抽取北京市某三甲精神专科医院的280名护士进行问卷调查,采用单因素方差分析、多元线性回归分析方法分析影响因素。结果精神专科医院护士第二受害者负性体验报告率较高,经验与支持得分较高的维度是“心理痛苦”和“离职倾向”。不同年龄段、不同工作年限、经历患者安全事件、直接经历次数不同的护士群体在经验与支持量表总分上有统计学差异（P＜0.05）;直接和间接经历患者安全事件是精神专科医院护士第二受害者经验与支持水平和离职倾向的共同影响因素;年龄＞45岁是精神专科医院护士第二受害者经验与支持水平和缺勤的共同影响因素。结论精神专科医院管理者应重视护士第二受害者的身心健康,建立支持型的安全文化和相应支持性项目,以确保其安全。     

The simultaneous detection of trivalent & hexavalent chromium in exhaled breath condensate: A feasibility study comparing workers and controls

The analytical method outlined in this feasibility study has been used to show that trivalent chromium (Cr(III)) and hexavalent chromium (Cr(VI)) can be detected and measured in exhaled breath condensate (EBC) samples. EBC samples and urine samples were collected from a cohort of 58 workers occupationally exposed to hexavalent chromium compounds and 22 unexposed volunteers (control group). Levels of Cr(III) and Cr(VI) were determined in EBC samples and total chromium levels were determined in urine samples. Pre and post working week samples for both EBC and urine were collected in tandem. Total chromium in urine samples was analysed by inductively coupled plasma mass spectrometry (ICP-MS). Analysis of Cr(III) and Cr(VI) in EBC samples used a hyphenated micro liquid chromatography (μLC) system coupled to an ICP-MS. Separation was achieved using an anion exchange micro-sized column. The results showed that the occupationally exposed workers had significantly higher levels of Cr(III) and Cr(VI) in their EBC samples than the control group, as well as higher levels of total chromium in their urine samples. However, for the exposed workers no significant difference was found between pre and post working week EBC samples for either Cr(III) or Cr(VI). This study has established that Cr(III) and Cr(VI) can simultaneously be detected and measured in ‘real’ EBC samples and will help in understanding inhalation exposure.     

The Relationship of Housing and Population Health: A 30-Year Retrospective Analysis

Objective

We analyzed the relationship between health status and housing quality over time.

Methods

We combined data from two nationally representative longitudinal surveys of the U.S. population and its housing, the National Health and Nutrition Examination Survey and the American Housing Survey, respectively. We identified housing and health trends from approximately 1970 to 2000, after excluding those trends for which data were missing or where we found no plausible association or change in trend.

Results

Changes in housing include construction type, proportion of rental versus home ownership, age, density, size, moisture, pests, broken windows, ventilation and air conditioning, and water leaks. Changes in health measures include asthma, respiratory illness, obesity and diabetes, and lead poisoning, among others. The results suggest ecologic trends in childhood lead poisoning follow housing age, water leaks, and ventilation; asthma follows ventilation, windows, and age; overweight trends follow ventilation; blood pressure trends follow community measures; and health disparities have not changed greatly.

Conclusions

Housing trends are consistent with certain health trends over time. Future national longitudinal surveys should include health, housing, and community metrics within a single integrated design, instead of separate surveys, in order to develop reliable indicators of how housing changes affect population health and how to best target resources. Little progress has been made in reducing the health and housing disparities of disadvantaged groups, with the notable exception of childhood lead poisoning caused by exposure to lead-based paint hazards. Use of these and other data sets to create reliable integrated indicators of health and housing quality are needed.