利氧灵提高人体高原劳动能力效果评价

本文通过高原现场观察,对利氧灵提高人体高原劳动能力的效果进行了评价。20名受试者以配对实验设计分为实验组(利氧灵组)和对照组,每组10人。先在平原测量无氧阈(AT_(GE)),PWC_(170)和定量负荷运动心率(HR)。而后,乘飞机到达海拔4370m高原,重复上述指标的测量。结果表明,在该高度上停留一周时间里,两组的AT_(GE)、PWC_(170)明显低于平原对照值,HR明显高于平原对照值。但在同一时间里,实验组的上述指标明显好于对照组,如第5天,实验组的TI_(GE)、PWC_(170)和HR分别为529.2kg·m/min,1216.4kg·m/min和160b/min;对照组分别为362.6kg·m/min(P<0.05),1016.1kg·m/min(P<0.05)和170b/min(P<0.05)。可见,利氧灵对提高人体高原劳动能力有一定作用。     

急进高原和高原训练对武警新兵血氧血压综合参数的影响

目的观察武警新兵急进高原和高原训练对血氧血压综合参数的影响,为探讨新兵高原习服提供科学依据。方法将受试者分为平原男性组、平原女性组、高原男性组和高原女性组。平原男性组分别在平原、急进高原的第1、第3、第5、第7天和新兵训练结束后测试。平原女性组在平原和高原训练前后测试。高10原男性组和高原女性组在高原训练前后测试。实验于2008年在成都和拉萨完成。结果平原男性组、平原女性组急进高原动脉血氧饱和度降低,差异有统计学意义(P<0.01);平原男性组在急进高原的第7天恢复到世居同龄人水平;高原训练前后血氧饱和度差异无统计学意义。平原女性组急进高原后血压升高,差异有统计学意义(P<0.01,P<0.05);平原男性组和平原女性组急进高原后脉率增快,差异有统计学意义(P<0.05,P<0.01)。结论血氧饱和度在急进高原7 d时基本习服,高原训练对血氧饱和度的影响不显著。     

急进高原自主神经功能变化与急性高原反应的关系

目的研究急进高原前、后心血管自主神经(autonomic nervous system,ANS)功能变化及其与急性高原反应(acute mountain sickness,AMS)之间关系,揭示ANS在AMS发病中的作用,探求预防AMS的可能途径。方法对99名健康男性青年在海拔450m平原和空运急进3700m高原后2~4d内进行心率变异性(heart rate variability,HRV)和冷加压试验(cold pressor test,CPT)检测;在急进高原后1~5d接受AMS发病情况调查。结果急进高原后第1天AMS发病率92%,其中,中重度AMS占10%、轻度占36%、基本无反应占54%。LF/HFn随AMS程度减轻而减少,HFn随AMS程度加重而增加。中重度、轻度、基本无AMS反应组平原时收缩压(SBP)分别为(123.42±7.14)mmHg、(120.6±11.22)mmHg、(122.58±10.92)mmHg,均显著高于无反应组(111.31±9.48)mmHg,(P<0.05);中重度AMS组在平原CPT后心率(HR)变化幅度〔(7.57±8.22)b/min〕显著低于基本无反应组〔(25.47±19.26)b/min,(P<0.05)〕。急进高原后,中重度、轻度、基本无AMS反应组CPT后SBP变化幅度分别为(8.14±4.95)mmHg、(9.56±7.77)mmHg、(9.97±6.80)mmHg,均显著低于无反应组〔(17.00±12.75)mmHg,(P<0.05)〕;HR变化幅度分别为(11.13±6.08)b/min、(10±7.5)b/min、(12.25±8.14)b/min,均显著低于无反应组(〔19.71±9.35)b/min,P<0.05〕。AMS症状积分与平原时LF/HF正相关(r=0.437,P<0.01),与平原时CPT后HR变化幅度呈负相关(r=-0.35,P=0.01)。结论平原交感神经活动较高者其ANS的应激调节能力相对较小,对AMS易感性较高。改善ANS功能可能有助于预防AMS。     

妊娠期女性尿液污染对尿干化学及尿沉渣检测影响的原因分析及干预

目的评价妊娠期女性尿液污染对尿干化学及尿沉渣定量检测的影响。方法门诊收集189例无泌尿道感染临床症状的妊娠期女性中段尿,用SYSMEX UF-1000i尿液沉渣分析仪和AUTION MAX全自动尿液分析仪对尿液标本进行检测,其中红细胞(RBC)、白细胞(WBC)、尿蛋白、上皮细胞(EC)阳性的孕妇经过外阴清洗后重新留取尿液进行检测。结果对189例妊娠孕妇外阴清洗前后留取中段尿进行尿干化学法比较,发现尿蛋白阳性率从83.1%下降到清洗后的37.6%(χ^2=81.745,P<0.01)、白细胞阳性率从76.2%下降到53.4%(χ^2=21.449,P<0.01)。尿沉渣检测清洗后上皮细胞(EC)及镜下WBC均明显低于清洗前,上述差异有统计学意义(t值分别为6.282、4.062,P<0.01),镜检RBC 2组间比较差异无统计学意义(t=0.960,P>0.05)。结论正确的留取尿液标本对尿干化学及尿沉渣检测的准确性至关重要,为临床对于妊娠期女性泌尿系感染的诊断提供准确的检验结果。     

进驻高原初期军人习服状况对脑力作业能力的影响研究

目的研究部队进驻高原初期不同低氧习服时间对脑力作业能力的影响以及个体习服状况与脑力作业能力之间的相关性。方法对进驻高原3700 m部队2天组(108人)、7天组(52人)、30天组(73人)和平原对照组(90人)的脑力作业能力(颜色选择反应时,听觉选择反应时,注意力,客体工作记忆,动作敏捷性,空间工作记忆),血氧饱和度进行测试,并进行急性高原反应(AMS)问卷调查与相关分析。结果颜色选择反应时高原2天组高于平原组(P<0.01)。注意力、动作敏捷性、空间工作记忆成绩高原各组均低于平原组(P<0.01),其中,动作敏捷性成绩高原7天组最低(P<0.01)。注意力和空间工作记忆成绩高原30天组最低。除动作敏捷性测试与血氧饱和度(SaO2)呈显著正相关(r=0.247,P<0.05),其他脑力测试成绩与SaO2、AMS评分之间无显著相关性,头痛和气短两个单项症状与部分认知能力有相关性。结论高原低氧环境对脑力作业能力有显著影响,在高原习服30天内,部分认知功能随习服时间延长逐渐好转,但仍低于平原水平。部分认知功能随习服时间延长而降低,出现SaO2下降以及头痛、气短症状者更易出现脑力作业能力的下降。     

pH值和尿蛋白水平对尿液分析仪管型检出率的影响

目的分析探讨pH值和尿蛋白水平对尿液分析仪管型检出率的影响。方法选取2015年9月—2016年9月我院收治的600例新鲜尿液标本,根据标本尿蛋白是否为阳性分为尿蛋白阳性组(n=400),尿蛋白阴性组(n=200)。600例标本均分别采用尿液分析仪和人工显微镜检测,比较两种检测方法的真阳性率和标本真阳性、假阳性与pH之间的关系。结果 400例尿蛋白阳性组患者中,尿液分析仪检测显示298例有管型,102例无管型。另外,尿液分析仪检测的真阳性高于人工显微镜镜检(P0.05),且人工显微镜镜检检测尿蛋白阴性但管型阳性的真阳性率为17.50%。最后,600例标本中人工显微镜镜检真阳性为177例,其中pH6.0的标本145例,占比81.92%;人工显微镜镜检真阳性为35例,pH均6.0;另外,324例假管型中,pH≥6.0的标本有281例,占比86.67%。结论尿液分析仪可作为尿液管型检测的初筛方法,有助于提高管型的检出率和工作效率。     

高原移居者返平原后血液学及血中MDA和SOD的变化观察

目的探讨高原移居者返平原后不同时间血液学及血中丙二醛(MDA)和超氧化物岐化酶(SOD)的变化。方法高原移居者返平原后第7天、60天、180天的40名健康青年学生(观察组)进行血常规、MDA和SOD测定,并与40名平原健康青年学生(对照组)作对照。结果对高原移居返回平原青年学生进行血常规指标检测,结果显示:返回平原后初期,观察组血中血红蛋白(Hb)、红细胞压积(HCT)均显著高于对照组,血小板计数(PLT)显著低于对照组,差异有统计学意义(P<0.05),观察组血中MDA检测值显著高于对照组,SOD检测值低于对照组,差异有统计学意义(P<0.05)。并随着时间的推移,这种差异在减小,在90天时比较接近于平原组。结论高原脱适应症状的产生与氧自由基损伤有相关性。     

尿MA检测在高血压肾病早期诊断中的意义

目的探讨尿微量白蛋白定量检测在高血压肾病早期诊断中的意义。方法 70例原发性高血压患者根据用药情况分为间断用降压药治疗组(A组,35例)和坚持用降压药治疗组(B组,35例),同时选取40例健康者为正常对照组(C组)。对上述观察对象分别进行24h尿微量白蛋白定量检测和尿蛋白定性检查,统计检测结果后比较两种方法的精确性。结果高血压各组尿MA定性和定量结果均明显高于健康对照组,其差异有统计学意义(P<0.01),且A组尿MA水平和阳性率明显较B组高(P<0.05)。尿微量蛋白检测阳性率明显高于尿蛋白定性(P<0.05)。结论尿微量蛋白定量检测是一种判断原发性高血压早期肾损害程度的有效方法。     

急性高原病发病前后血管内皮生长因子及其受体水平变化

目的探讨人群急进高原前后血管内皮生长因子(vascular endothelial growth factor,VEGF)和受体VEGFR-1(fms-like tyrosine kinase-1,flt-1)、VEGFR-2(fetal liver kinase-1/kinase insert domain-containing receptor,flk-1/KDR)的表达变化及其与急性高原病(acute mountain sickness,AMS)发病的关系,为发现和保护易感人群提供理论依据。方法以2000名健康新兵为研究对象,分别在急进高原前后抽取静脉血备用。以症状评分法调查急进高原后AMS的发病率,随机选取20名AMS发病对象为AMS组,20名未发病对象为对照组,采用ELISA法检测急进高原前后两组血浆VEGF、VEGFR-1、VEGFR-2浓度的变化。结果 2000名研究对象中AMS的发病率为34.3%。与平原地区相比,AMS组急进高原后血浆VEGF浓度明显升高且差异有统计学意义(t=2.799,P=0.011),血浆VEGFR-1和VEGFR-2浓度无明显变化;对照组急进高原后血浆VEGF、VEGFR-1和VEGFR-2浓度变化无统计学意义(P0.05)。急进高原前后AMS组血浆VEGF浓度均明显高于对照组(t=2.461,P=0.018;t=2.698,P=0.010),而血浆VEGFR-1、VEGFR-2浓度与对照组相比均无明显差异。结论血浆VEGF浓度有可能作为一个敏感指标在急进高原前筛选AMS易感者,而血浆VEGFR-1、VEGFR-2浓度与AMS的发生无相关性。     

海拔5000米高原急性高山病的发病率及影响因素和伴随症状

本文对进入海拔5000m高原的62例健康人的急性高山病(AMS)的发病率,影响因素及伴随症状进行了现场调查.总AMS发病率为48.4%,发生高原肺水肿1例(1.6%),上山后4天出现外周水肿18例(29%),一周后水肿逐渐消退.72%水肿患者同时合并AMS,提示外周水肿可能和AMS有某种内在联系.年龄及原居住地海拔高度与AMS发病率无明显关系.有居住3500m以上高原史组AMS发病率明显低于无居住高原史组.本文还对AMS一系列伴随症状进行了讨论.     

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.     

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.     

Assessing occupational and environmental exposure

Exposure assessment is a poorly understood component of the science of epidemiology. The relationship between exposure to chemicals and ill-health outcomes is often calculated using crude exposure measures such as ever/never exposed or duration. When investigating subtle effects, exposures need to be characterized much more fully in terms of intensity, frequency, duration and route. While occupational exposures tend to be much greater than those experienced from the wider environment there is a need to remember that, for many chemicals, exposure can occur occupationally, environmentally and through consumer use of products containing the material of interest. Inhalation exposure has generally been the traditional focus for most epidemiological investigations but there is now growing awareness of the importance of the dermal and ingested routes of contact and internalization. Quantification of the exposure also needs to be related to a biological mechanism of action and exposure metrics need to be selected accordingly. Occupational exposures can generally be measured using simple well-validated techniques. Environmental exposures require much more sensitive instruments and are more difficult to assess. Exposure modelling, particularly for the environmental fate of chemicals has undergone many recent developments and Monte Carlo techniques can be used to characterize model uncertainty and variability. This approach to exposure assessment can now be used in the setting of the wider environment and will enable a far better understanding of the relationship between exposure and disease.     

Mercury toxicity due to the smelting of placer gold recovered by mercury amalgam

A 19-year-old man developed tremor in both hands and fatigue after starting work at a placer gold mine where he was exposed to mercury-gold amalgam. Examination revealed an intention tremor, dysdiadochokinesis and mild rigidity. The 24-h urinary mercury concentration reached a peak of 715 nmol/l (143 ug/l) shortly before the clinical examination, after which he was removed from working in the gold room [Mercury No. Adverse Effect Level: 250 nmol/l (50 ug/l)]. On review 7 weeks later his tremor had almost resolved and the dysdiadochokinesis and rigidity had gone. The 24-h urinary mercury concentration had fallen to 160 nmol/l (32 ug/l). The principal exposure to mercury was considered to be the smelting of retorted gold with previously unrecognized residual mercury in it. The peak air concentration of mercury vapour during gold smelting was 0.533 mg/m3 (Mercury Vapour ACGIH TLV: 0.05 mg/m3 TWA). Several engineering and procedural controls were instituted. This episode occurred at another mine site, unrelated to Mount Isa Mines Limited.     

How Adults with Acquired Brain Damage Perceive Computer Training as a Rehabilitation Tool: A Focus-group Study

The aim of this study was to explore and describe how adult outpatients with acquired brain damage and referred to occupational therapy perceive computer training with the RehaCom programs, in order to evaluate the method of treatment as a tool in the rehabilitation of persons with cognitive disorders. By using focus-group discussions as a qualitative method of research when analysing the result, five themes with corresponding categories emerged, describing a development of understanding and learning about capacities. Themes describing how the participants could apply strategies to overcome shortcomings in daily occupations and the therapeutic role of the occupational therapist were identified as well. The result shows that a computer training program such as RehaCom can be used as an educational tool, for example, to guide a person who is trying to adopt compensatory strategies to avoid overload by taking pauses. It was found that anything the participants learned was also applicable to occupational performance in daily life.