The dermal toxicity of cement

Cement and concrete are products used widely in the construction sector, with a traditional perception that any hazards that they have are limited to dermatitis in a small number of workers. In some cases, employers and builders do not think that concrete is a chemical. However, contact dermatitis is one of the most frequently reported health problems among construction workers. A review of the available literature suggests that cement has constituents that produce both irritant contact dermatitis and corrosive effects (from alkaline ingredients such as lime) and sensitization, leading to allergic contact dermatitis (from ingredients such as chromium). These findings indicate that cement and concrete should be treated as hazardous materials, and that workers handling such products should reduce exposure wherever possible. Initiatives to reduce the chromium content of cement have been shown to be successful in reducing the incidence of allergic dermatitis, although the irritant form remains.     

Respiratory Function and Disease among Workers in Alkaline Dusts

Little is known of the possible effects of sodium carbonate dust on the lower respiratory passages. A large alkali industry, with a number of works, was used for an investigation of lime and soda ash dusts evolved during the process. The physical and chemical characteristics of these dusts and details of the type of work and environmental conditions are described. In 1954 and 1956 a survey was made of respiratory sickness absence, chest radiographic appearance, and respiratory function in workers employed in areas with exposure to soda ash, lime dust, and no dust. All were interrogated about their smoking habits. In 1954 there was found to be a significant reduction in expiratory flow rate of workers in dusty jobs in soda ash compared with the group not exposed to dust but this result was nullified in a random sample group in 1955 and in full groups in 1956. Respiratory sickness absence was found to be slightly greater in workers in dusty occupations, particularly in lime dust. No pneumoconiosis was detected on miniature films. The survey of smoking habits revealed that smoking was associated with a definite decrease in the expiratory flow rate, particularly after the age of 40 in heavy smokers. It was concluded that smoking habits played a more important part than alkaline dusts in the reduction of respiratory efficiency as measured by a study of sickness absence and performance of a simple spirometric test.     

Grand rounds: an outbreak of toxic hepatitis among industrial waste disposal workers

CONTEXT: Industrial waste (which is composed of various toxic chemicals), changes to the disposal process, and addition of chemicals should all be monitored and controlled carefully in the industrial waste industry to reduce the health hazard to workers. CASE PRESENTATION: Five workers in an industrial waste plant developed acute toxic hepatitis, one of whom died after 3 months due to fulminant hepatitis. In the plant, we detected several chemicals with hepatotoxic potential, including pyridine, dimethylformamide, dimethylacetamide, and methylenedianiline. The workers had been working in the high-vapor-generating area of the plant, and the findings of pathologic examination showed typical features of acute toxic hepatitis. DIScussION: Infectious hepatitis and drug-induced hepatitis were excluded by laboratory findings, as well as the clinical course of hepatitis. All cases of toxic hepatitis in this plant developed after the change of the disposal process to thermochemical reaction-type treatment using unslaked lime reacted with industrial wastes. During this chemical reaction, vapor containing several toxic materials was generated. Although we could not confirm the definitive causative chemical, we suspect that these cases of hepatitis were caused by one of the hepatotoxic agents or by a synergistic interaction among several of them. RELEVANCE TO CLINICAL OR PROFESSIONAL PRACTICE: In the industrial waste treatment process, the danger of developing toxic hepatitis should be kept in mind, because any subtle change of the treatment process can generate various toxic materials and threaten the workers' health. A mixture of hepatotoxic chemicals can induce clinical manifestations that are quite different from those predicted by the toxic property of a single agent.     

深圳市参加与未参加劳务工医疗保险的卫生服务需求与利用比较研究

目的:了解参加与未参加劳务工医疗保险的劳务工卫生服务需求和利用的不同,为推动劳务工医疗保险制度的健康发展提供依据。方法:采用整群随机抽样的方法,分别对深圳市2080名参加与2554名未参加劳务工医疗保险的劳务工卫生服务需求、利用等进行问卷调查。结果:(1)参保人员两周患病率为25.53%,未参保人员两周患病率为22.24%;(2)参保人员两周患病就诊率为20.10%,未参保人员两周患病率为15.47%;(3)参保人员住院率为3.56%,未参保人员住院率为3.05%;(4)参保人员两周患病就诊单位主要是社康中心(42.44%)和街道医院(22.69%),未参保人员主要是个体诊所(32.45%)和社康中心(23.40%);(5)参保人员次均住院费用、间接费用分别为2723.4、837.7,未参保人员分别为1890.5、665.6。结论:参保人员两周患病率、两周患病就诊率均高于未参保人员;卫生服务可及性差;一些医疗机构存在诱导现象;参保病人流向较为合理。     

深圳市龙岗街道流动工人的职业健康监护现况

目的了解流动工人职业健康监护情况,分析流动工人职业健康监护中存在的问题,为相关部门对流动工人的管理提供参考。方法对深圳市龙岗街道在有职业病危害企业工作的1 200名流动工人进行现场问卷调查,对调查数据进行统计分析。结果流动工人上岗前、在岗期间职业健康检查率分别为17.1%、57.3%;流动工人职业健康监护率远低于固定工人;职业健康检查费用以用人单位支付为主。结论流动工人职业健康监护状况不容乐观,应加大职业健康监护监督力度;职业健康检查双重标准现象突出,应规范企业用工制度;健康检查费用未能全部实现由用人单位承担,应调整工伤保险的工作机制。     

Effects of informing workers of their health risks from exposure to toxic materials

This study compared the mental health, attitudes, and smoking behaviors of 133 workers who had been informed of health risks from exposure to toxic materials on the job with 137 workers who worked in similar conditions but who had not been told that their health was at risk because of exposure to toxic materials. The informed workers reported more health problems than controls, but there were no significant differences between the informed and uninformed groups in mental health, attitudes toward health hazards in or outside of the workplace, or in smoking rates. Ninety percent of all respondents felt that exposed workers definitely should be told of their health risks. These findings indicate little psychological risk from informing workers about their risks because of exposure to toxic substances and a strong desire on the part of workers to be informed.     

贵州省5城市男性农民工生殖健康状况调查

摘要:目的　了解男性农民工的生殖健康状况,提出改善男性农民工生殖健康状况的可行性建议。方法　在贵州省5城市随机选取250男性农民工进行结构式问卷调查,并对其中15名对象进行面对面的深入访谈,运用SPSS19.0分析软件对所得数据进行频数、单因素方差和相关分析。结果　62.40%的已婚男性农民工与配偶分居。18.80%的未婚和未与配偶同住的已婚男性农民工的性伴侣为女朋友、同居伴侣、性工作者。39.40%的人在近3个月曾出现生殖系统不适的症状。但仅有6.60%的受访者选择去看医生。72.00%的受访者表示对生殖健康知识不太了解,仅有1.50%表示全部读过获得的生殖健康/计划生育宣传品。结论　男性农民工受教育程度普遍不高,居住环境较差,身体处于亚健康状态的比例较高。避孕参与率低,避孕药具较为单一。生殖健康知识缺乏。建议:通过城乡一体化发展,实现“家庭团聚”;改善农民工的生活环境;打破城乡二元结构,减轻农民工的后顾之忧;加强成人教育培训,提高农民工的受教育水平和提供形式多样的生殖健康宣传教育等来改善农民工的生殖健康水平。     

乡镇卫生院人员对激励机制的满意度研究

目的了解乡镇卫生院员工对激励制度现状的满意度。方法从经济发展水平不同的2个县中抽取8个乡镇,共调查8家乡镇卫生院的员工213人。结果大部分乡镇卫生院员工对收入水平、福利保障状况持不满意的态度。对管理环境、职业发展等其他激励因素,持中立态度的员工比例较高。结论为提高乡镇卫生院员工的工作积极性,应首先加大政府的卫生投入力度,并切实将投入转化为卫生技术人员收入和福利水平的提高。在此基础上,结合改进人员培训体系、改善支付方式和完善机构技术设备等其他激励方式。     

Implementation rate of periodic health checkup at manufacturing factories in Kawasaki]

A questionnaire survey on periodic health checkup was conducted on 4,432 manufacturing factories in Kawasaki and the following results were obtained. 1) Implementation rate of periodic health checkup was 100% in factories with 100 workers or more. In smaller factories employing less than 100 workers, the implementation rate decreased with decrease in their total work force. The rate was 47.5% and 37.7% in factories with 9-4 and 3-1 workers, respectively. 2) The proportion of workers less than 30 years of age decreased and that of 60 or more years of age increased with decreasing size of the total work force. Distribution of both age groups was 12.6% and 12.9%, respectively in factories with less than 10 workers. The proportion of female workers increased from about 10% in factories with 300 workers or more to 26.8% in factories with less than 10 workers. 3) In large factories with 500 workers or more periodic health checkups were implemented mostly at their own or related medical facilities and in factories with 499-10 workers, almost 50% were implemented in independent health service facilities. In factories with less than 10 workers periodic health checkup were implemented mainly at health centers (33.1%) and at hospitals or clinics (26.9%). 4) The main reasons why small factories could not implement periodic health checkup were: (1) they could not afford the time for the implementation (50.0%) and (2) ignorance of the law of mandatory periodic health checkup for workers (23.6%).     

接触低剂量X射线对医务人员血细胞及微核率的影响

目的　探索长期接触低剂量X射线对医务人员血液系统及其遗传物质的影响 ,为当前放射医务人员的卫生防护工作提供依据。方法　对 115名接触低剂量X射线的医务人员作外周血细胞及淋巴细胞微核分析。结果　在低剂量 ( 0 45mSv/a)X射线条件下 ,放射医务人员淋巴细胞微核异常率随着X射线接触剂量和接触工龄增加而增高 (P <0 0 5 ) ,但未出现明显的白细胞减少现象。结论　在目前剂量情况下 ,本区接触X射线医务人员的身体未发现明显影响。     

某区低浓度苯系物作业场所与工人职业健康监护现状调查

目的探讨区域内企业工人低浓度苯系物防护状况、接触水平、管理现状及其对工人健康影响的特点,为企业制定健康监护策略和采取有效措施保护工人身体健康提供依据。方法对企业工作场所现状进行调查,并对空气中苯、甲苯、二甲苯浓度进行监测,对低浓度苯系物接触工人进行职业健康监护,将相应企业不接触苯的工人作为内对照,对健康监护资料进行统计分析。结果该企业职业健康监护977人,查出各类实验室检查结果异常者244人(361项次),异常率为24.97%;低浓度苯系物接触工人的白细胞计数下降人数与对照组比较差异有统计学意义(χ2=39.89,P0.01)。结论在现有的防护状况和管理措施下,从事低浓度苯系物作业的工人出现比较明显的外周白细胞计数改变,需要进一步依法加强对低浓度苯系物作业工人的健康监护并改善劳动环境。     

Health workers at the core of the health system: framework and research issues

This paper presents a framework for the health system with health workers at the core. We review existing health-system frameworks and the role they assign to health workers. Earlier frameworks either do not include health workers as a central feature of system functioning or treat them as one among several components of equal importance. As every function of the health system is either undertaken by or mediated through the health worker, we place the health worker at the center of the health system. Our framework is useful for structuring research on the health workforce and for identifying health-worker research issues. We describe six research issues on the health workforce: metrics to measure the capacity of a health system to deliver healthcare; the contribution of public- vs. private-sector health workers in meeting healthcare needs and demands; the appropriate size, composition and distribution of the health workforce; approaches to achieving health-worker requirements; the adoption and adaption of treatments by health workers; and the training of health workers for horizontally vs. vertically structured health systems.     

社区卫生服务培训需求调查

目的：分析成都、沈阳两项目市(城市社区卫生与贫困医疗救助)社区卫生服务的培训需求，为项目设计培训计划提供参考。方法：社区卫生服务机构与人员的问卷调查、卫生人员专题小组讨论、机构领导深入访谈。结果：卫生人员的背景和所具知识、技能尚不能完全胜任社区卫生服务，卫生人员本身和领导都表示了培训的需求，并对培训内容、方式、对象、费用等提出了具体看法和希望。结论：加强两项目市杜区卫生人员的培训有必要也有可能。注意周密、完善培训计划；社区卫生管理人员和技术人员的培训齐抓并管；岗位任务分析；因地制宜；多种形式结合，注重社区实践。     

Mental health status of municipal solid waste incinerator workers compared with local government office workers

Recently in Japan dioxin problem of municipal solid waste incinerator (MSWI) became social issue. The news spread all around Japan and induced fear that workers at incinerators would suffer from cancer or other serious illness induced by the exposure to dioxins. Authors were interested in the effect of this stressful event occurred to the workers and intended to evaluate mental health status of MSWI workers compared with office workers. Subjects were male workers from two MSWI plants and a local government office; 20 government office workers who were engaging in health administration and 55 MSWI workers. Subjects were interviewed about their age, educational carrier, and working schedule. POMS and GHQ30 were used to evaluate mood status of subjects. There were differences in mood state between the two occupational groups. POMS showed that Tension-Anxiety, Depression-Dejection, and Fatigue levels were high in the health administration worker group. GHQ30 showed that General Illness, Social Dysfunction, and Anxiety and Dysphoria state were deviated to abnormal in the health administration worker group. General mental health status evaluated by GHQ30 score was also deviated to abnormal in the office worker group. Our results showed that mental health status of health administration workers was less healthy compared with MSWI workers. This meant that the stress of MSWI workers enhanced by the fear that they might have been exposed to dioxin did not exceed the stress the health administration workers usually had suffered from.     

'We are also dying like any other people, we are also people': perceptions of the impact of HIV/AIDS on health workers in two districts in Zambia

In countries with a high AIDS prevalence, the health workforce is affected by AIDS in several ways. In Zambia, which has a prevalence rate of 16.5%, a study was carried out in 2004 with the aim to: explore the impact of HIV/AIDS on health workers, describe their coping mechanisms and recommend supportive measures. The qualitative study was complemented by a survey using self-administered questionnaires in four selected health facilities in two rural districts in Zambia, Mpika and Mazabuka. It is one of the few studies to have explored the impact of HIV/AIDS from the perspective of health workers and managers in the region. Thirty-four in-depth interviews and five group discussions were conducted with health workers, managers and volunteers, and 82 self-administered questionnaires were filled out by health workers. In addition, burnout among 42 health workers was measured using the Maslach Burnout Inventory (MBI). The MBI measures three components that contribute to burnout: emotional exhaustion, depersonalization and personal accomplishment. The results show that in both districts, HIV/AIDS has had a negative impact on workload and has considerably changed or added tasks to already overburdened health workers. In Mpika, 76% of respondents (29/38), and in Mazabuka, 79% (34/44) of respondents, expressed fear of infection at the workplace. HIV-positive health workers remained 'in hiding', did not talk about their illness and suffered in silence. Despite the fact that health workers were still relatively motivated, emotional exhaustion occurred among 62% of the respondents (26/42). The interviews revealed that counsellors and nurses were especially at risk for emotional exhaustion. In each of the selected facilities, organizational support for health workers to deal with HIV/AIDS was either haphazardly in place or not in place at all. AIDS complicates the already difficult work environment. In addition to health workers, management also needs support in dealing with AIDS at the workplace.     

云南边境少数民族艾滋病低流行地区预防保健工作者相关知识、态度及需求

目的了解云南边境少数民族艾滋病低流行地区预防保健工作者艾滋病知识、态度、开展宣传教育的困难及对艾滋病知识和信息的需求.方法选择怒江傈僳族自治州福贡县全体预防保健工作者作为调查对象,进行问卷调查及个人访谈,并对问卷进行统计分析.结果预防保健工作者对艾滋病传播知识掌握较好,但对艾滋病深入一点的专业知识知晓率却很低,问卷平均得分为56.71,知识知晓状况与是否参加过培训相关.结论应加强边境少数民族艾滋病低流行区预防保健工作者艾滋病的教育,传授宣传教育的技能.     

甘肃省某县乡、村卫生人员现状调查

[目的]了解甘肃省某县所有乡(镇)、村现有卫生人员的状况.[方法]统一问卷,利用乡、村医生例会、培训学习和深入乡、村工作时间,对全县23所乡(镇)卫生院的工作人员的现有状况进行了调查.[结果]乡、村卫生人员严重匮乏,综合素质低下,人员结构不合理.乡级卫生院缺编,卫生人才严重不足,与农民群众的医疗卫生需求不相适应,难以承担乡村医疗和预防保健任务.[结论]应加大对农村卫生资源的经费投入,加强卫生人员的在职教育,提高现有人员的综合素质.     

Training health workers: What needs to be taught and who should teach it

The training of many health workers has been inadequate in producing workers who can function effectively in rural health services. This inadequacy is seen in two areas. While health workers are well drilled in technical procedures, operational strategies for applying these procedures in the conditions of rural health services are often lacking; and much of what they are taught is inappropriate in terms of the practicalities of working in rural areas. Two aspects of training are then discussed. What is taught and who teaches it. A distinction is made between teaching routine technical procedures and teaching cognitive strategies for problem-solving. These need to be distinguished and both considered when training health workers. The use of health workers themselves as trainers of other health workers is then considered. They often do not have the confidence necessary to teach in open participatory, discussion-centred ways. These ideas are then briefly considered in the light of a training scheme in Kenya, and how it has been used for training in Primary Eye Care.     

城乡基层医疗人员对气候变化及其健康风险认知的差异

目的探究基层医疗人员对气候变化及其健康风险认知的城乡差异。方法采用分层随机整群抽样,抽取广东省21家城区和10家乡镇基层医疗卫生机构的医疗人员进行问卷调查,收集其基本信息和对气候变化及其健康风险的认知情况,通过卡方检验、秩和检验和logistic逐步回归分析探究气候变化认知的城乡差异。结果63.8%(468/733)的基层医疗卫生人员认同气候变化正在发生,55.4%(406/733)的人认为气候变化主要归因于人类活动。城区卫生人员对气候变化正在发生的认同程度高于乡镇,而城区与乡镇对气候变化发生原因的认知差异不明显。城区人员在高温热浪的健康风险认知上略高于乡镇,而对于气候变化与传染病关联的认知略低于乡镇,但差异不具有统计学意义。乡镇人员识别气候变化脆弱人群的能力略高于城区,差异具有统计学意义。此外,职称级别越高越能感知气候变化健康风险;临床医生相比于护士和公共卫生人员更认同气候变化正在发生且更能识别其发生原因。结论城区基层医疗卫生人员在气候变化正在发生的认同程度上略高于乡镇,但是乡镇医疗卫生人员比城区的更能识别脆弱人群。城区与乡镇基层医疗卫生人员对气候变化及其健康风险认知均不容乐观,应积极采取措施提升风险认知以增强其应对气候变化健康风险的能力。