职业性哮喘70例的职业特征

目的了解职业性哮喘病例的职业史特点。方法对诊断为职业性哮喘的70例患者的职业史进行调查、分析。结果患病平均年龄为40．37岁，平均工龄为11．03a，平均发病潜伏期为5．35a。发病工种以喷漆、塑料加工（发泡）为主，职业危害因素以油漆（异氰酸酯）为主，防护措施较差，同工种发病率较高。结论职业性哮喘发病年龄较早，防护措施较差，工龄、潜伏期较短，从事喷漆、塑料加工的工人发生职业性哮喘的概率较高，有针对性的预防及早期诊断、早期治疗是控制职业性哮喘发作的关键。     

Occupational airway sensitizers: an overview on the respective literature

BACKGROUND: Worldwide, there is rigorous scientific activity concerning the further development of work safety regulations involving airway-sensitizing substances. Technical directives on hazardous substances are enforced in several countries and are being continuously updated. The European Union has established a code for several occupational substances, now labeled R 42 ("may cause sensitization by inhalation"). METHODS: We present an overview of the literature dealing with allergic occupational asthma. The literature was selected according to criteria of study design and diagnostic test methods. Approximately 300 publications were reviewed including both epidemiological studies and individual case reports. RESULTS: Airway sensitizers are systematically arranged and separately listed according to chemicals and their origin from animals, plants, and microorganisms. The clinical data as well as threshold limit values (TLV) and R 42 labeling of 250 airway-sensitizing substances are presented. CONCLUSIONS: The most common sensitizing substances causing occupational asthma were dust of cereal flours, enzymes, natural rubber latex, laboratory animals as well as low molecular substances such as isocyanates and acid anhydrides.     

我国职业病防治现状与对策分析

目的 综述我国职业病防治的现状,提出针对性对策建议。方法 以“职业病防治”、“职业卫生技术服务”“职业卫生检查”、“职业病诊断”、“工伤保险”、“职业卫生监督”作为CNKI数据库的检索词,检索参考文献15篇。结果 我国职业病防治立法及监管、职业卫生技术服务、职业健康检查和职业病诊断、以及工伤保险等存在诸多问题。结论 我国职业病防治现状不容乐观,需要采取适当措施提高职业病防治水平,保护劳动者健康。     

Opportunities and obstacles in translating evidence to policy in occupational asthma

Purpose

Occupational asthma (OA), a common respiratory disorder in Western countries, is caused by exposures at the workplace. It is part of a broader definition of work-related asthma (WRA) that also includes pre-existing asthma aggravated by substances present in the workplace environment, and it is potentially preventable. The purpose of this paper is to illustrate preventive measures for occupational asthma by case studies.

职业暴露异氰酸酯生物标志物的研究进展

异氰酸酯是导致职业性哮喘的主要致病因素之一,选择合适的异氰酸酯生物标志物,对开展异氰酸酯暴露的生物监测,实现异氰酸酯易感者的早期预警、早期干预等具有重要的意义。作者就职业暴露异氰酸酯生物标志物的研究进展做一综述,以期为更好地保护异氰酸酯暴露者提供依据。     

Occupational asthma caused by decorative flowers: review and case reports

Occupational respiratory symptoms caused by decorative flowers are seldom reported in the literature. In the years 1985–1993 four such cases of occupational asthma were diagnosed at the Institute of Occupational Health of Finland. Occupational asthma was caused by freesias (n = 1), chrysanthemums (n = 1), and tulips (n = 2). The diagnoses were based on work-related respiratory symptoms during flower handling in the patients' histories, specific challenge tests, and allergologic examinations. Flower allergy is rare but can even develop into occupational asthma. It usually leads to a change of profession.     

Challenges for the new century in the epidemiology of adult asthma

Numerous risk factors are associated with asthma. To achieve adequate precision in epidemiologic studies of asthma, large populations and specific diagnostic methods are to be preferred. The association between air pollution (in a wide sense) and adult-onset asthma is well-known, but little is known about the actual risks. In published studies the fraction of adult-onset asthma caused by occupational exposures ranges from 4.8% to 36%. Whether subjects with preexisting asthma are at an increased risk for impairment due to asthma when they are exposed to irritants is an issue of great relevance. The literature addressing these problems is scant. The challenge facing us is to design epidemiologic studies on adult asthma that lead to answers to the following questions: (i) has the incidence of asthma increased among adults, (ii) to what extent is adult-onset asthma caused by occupational exposure, (iii) does preexisting asthma get worse due to exposures in the workplace?     

Current diagnostic methods for diisocyanate induced occupational asthma.

BACKGROUND: Diisocyanates are among the most frequent causes of occupational asthma in industrialized countries. Early diagnosis of diisocyanate asthma followed by prompt termination of chemical exposure can prevent chronic morbidity due to persistent asthma. The accurate diagnosis of diisocyanate asthma requires a systematic approach that combines information obtained from the occupational history, immunologic tests and physiologic studies. METHODS: The advantages, limitations and validity of various methods and diagnostic guidelines utilized in the evaluation of diisocyanate asthma are reviewed. RESULTS: Recommended methods for evaluation of diisocyanates asthma are similar to approaches for other causative agents. Serologic assays of specific IgE are specific but insensitive diagnostic markers of diisocyanate asthma. If possible, workers should be evaluated, while at work, in order to demonstrate work-related changes in lung function associated with diisocyanate exposures. Specific bronchoprovocation challenge testing with diisocyanates, is reserved for situations where the diagnosis cannot be confirmed at work. Such tests can be performed safely but should be conducted exclusively at specialized centers by experienced personnel. CONCLUSIONS: Published diagnostic guidelines for occupational asthma are directly applicable to the evaluation of diisocyanate asthma.     

German cattle allergy study (CAS): public health relevance of cattle-allergic farmers

Introduction Allergic reactions caused by animals are a common and significant occupational health concern. In a large population-based study on occupational asthma in Europe, farming has been among the occupations with the highest risk. Objectives Characteristics of cattle-allergic farmers are described in a retrospective observational design. Methods The study covers farmers from all regions of Germany which were reported to the Agricultural Institutions for Statutory Accident Insurance and Prevention (Landwirtschaftliche Berufsgenossenschaften, LBGs) between 1990 (January) and 2002 (December) with a suspected occupational cattle-allergic airways disease. For these farmers, the following parameters were considered: age, gender, onset of airways symptoms related to contact with cattle, begin of employment disability, total and specific Immunoglobulin E (IgE) against cattle allergens, and results of lung function measurements. Results A total of 513 patients (age 14–74, mean 40.7 years; 45.6% women, 54.4% men) had been reported for a suspected occupational cattle-allergic airways disease. Of these patients 24.8% showed cattle-related symptoms of asthma, 11.7% of rhinitis, and 60% of both asthma and rhinitis, while only 34.5% of all reported patients showed an airways obstruction in the first documented lung function test. A total of 62.5% out of the group of patients with an officially recognized occupational disease (42.1%, n = 216) have an initial employment disability with a rating of 20% or above. Conclusions Our results underline the high public health relevance of cattle allergy in farmers, especially in the light of the large number of young patients. Considering the known difficulties in diagnosing cattle allergy due to the number of false negative test results, we are convinced that its relevance is even higher than the number of reported cases suggests. The high rate of initial employment disability among the affected patients underlines the need for improved preventive measures.     

The Use of Activities in the Treatment and Rehabilitation of Psychiatric Patients: An Overview

Activities have always been basic to the professional nature of occupational therapy. However, occupational therapists have, on the one hand, been criticized for over-valuing the media they use and, on the other hand, for discarding the use of activities and therefore discarding their professional essence. In an attempt to highlight the importance of “doing” in therapy, an overview of activities from a number of perspectives is presented, together with the contribution that activities make in the treatment and rehabilitation of psychiatric patients. The importance of structured and well co-ordinated programmes is stressed and the need for a better understanding of rehabilitation in psychiatry is suggested.     

Occupational asthma

Occupational asthma is an entity caused by conditions deriving from a certain work milieu and not from stimuli found outside the workplace. Nowadays, occupational asthma is the most frequent respiratory occupational disease in the majority of the industrialised countries and it is estimated that the proportion of new cases of asthma that can be attributed to exposure at work is around 10-15%. It can be developed due to an immunological mechanism or to a non-immunological mechanism. Influential in its development are the type of agent exposed to, the level and form of exposure and genetic factors of susceptibility. In the diagnostic process there is a concurrent confirmation that the patient has bronchial asthma and that this has been caused by occupational reasons. As shown by the natural history of the disease, an early diagnosis and the consequent posterior actions result in an improved prognosis.     

Cork workers’ occupational asthma: lack of association with allergic sensitisation to fungi of the work environment

Objectives To evaluate allergic sensitisation to Chrysonilia sitophila, Penicillium glabrum, and Trichoderma longibrachiatum in cork workers with asthma.Methods Skin prick tests with a battery of common allergens and with the three fungi were performed on ten cork workers with asthma and eight non-exposed asthmatics. Based on serial peak expiratory flow measurements, five were classified as having occupational asthma (AO) and five as having non-occupational asthma (NOA). In exposed patients, specific antibodies for the three fungi were also studied by immunoblottingResults Two out of ten patients with occupational exposure and four out of eight of the control group showed positive results for skin prick tests for common allergens. Moreover, two out of five patients with OA and three out of eight controls exhibited sensitisation to storage mites. All exposed patients (with OA or NOA) had negative skin prick test results for the fungal extracts. In patients with asthma and occupational exposure, immunoblotting results confirmed the absence of specific IgE. However, specific IgG4 was present in some cases.Conclusions Atopy does not seem to characterise occupational asthma in cork workers. Despite their long exposure to moulds, we could not find evidence of IgE sensitisation to the three most prevalent cork fungi in patients with OA, which points to the search for other causative agents, such as cork chemical compounds or contaminants.     

Assessment of occupational asthma

Although the true incidence of occupational asthma is not known, this disorder has been reported with increasing frequency in recent years. This article focuses on the diagnosis, management, prognosis and compensation of occupational asthma. Diagnosis of occupational asthma needs to be confirmed by objective means. There has been a general lack of uniformity in the diagnostic approach to the assessment of workers suspected of having occupational asthma. Once the disease has been diagnosed, the worker must be granted paid absence from work, and impairment and disability should be assessed periodically. It should be emphasized that the comments and recommendations contained in this article represent the views of the author and may not reflect the opinions of other investigators involved in the field of occupational asthma. The several unanswered questions raised in the article are intended to serve as a basis for a general discussion, with the aim of reaching a consensus and developing guidelines for the diagnosis and evaluation of occupational asthma in Italy.     

Asthma caused by potassium aluminium tetrafluoride: a case series

The objective of this study is to describe a case-series of potassium aluminium tetrafluoride (KAlF₄)-induced occupational asthma (OA) and/or occupational rhinitis (OR). The study involves five patients from a heat-exchanger production line who were examined (including specific inhalation challenge tests) for suspected OA and/or OR caused by a flux containing almost 100% KAlF₄ − with fluorides’ workplace air concentrations ranging between 1.7 and 2.8 mg/m³. No subject had a previous history of asthma. All five patients had a positive specific challenge test (three patients were diagnosed with OA alone, one with OR and one with both OR and OA). At the follow-up visit, after three years on average, all patients needed permanent corticosteroid therapy (four topical, one oral). After elimination from the exposure, only one of the observed subjects gave an indication of an improvement, two subjects stabilized and two worsened. Our case series focuses on the correlation between patients’ exposure to fluorides in air-conditioner production and the subsequent occurrence of OR/OA. Currently, it is uncertain whether these OR/OA were caused by hypersensitivity or irritation.     

Quaternary ammonium compounds and occupational asthma

Objective: Quaternary ammonium compounds, among which benzalkonium chloride is one of the best-known, are commonly used as antiseptics, disinfectants, detergents and preservatives. They can cause occupational asthma, which however, has been rarely reported so far, despite wide use of these products. We report three such cases. Possible mechanisms causing asthma are discussed, taking into account their characteristics. Methods and results: Our patients, all female nurses, manifested asthma symptoms upon handling disinfectant solutions containing benzalkonium chloride. Work-related fall in PEFR was observed in all of them. The diagnosis was confirmed by challenge tests where the patients were exposed, in a closed chamber, to suspected disinfectant contained in a tray. All of the women developed early or delayed symptoms upon exposure. Similar challenge tests to placebo or other disinfectants devoid of quaternary ammonium compound were negative. Conclusion: These three cases, in addition to others reported in the literature, point out an as yet poorly known etiology of occupational asthma to quaternary ammonium compounds in hospital employees. The exact mechanism of the action remains unexplained. Received: 20 October 1999 / Accepted: 25 March 2000     

广州市468名放射诊断工作人员职业健康管理相关知识知晓情况调查

目的 了解广州市医疗机构放射诊断工作人员职业健康管理相关知识知晓情况及其影响因素。方法 采用分层整群抽样方法,对来自省部级、市级、区级、社区和民营机构共468名放射诊断工作人员进行问卷调查。采用logistic回归进行职业健康管理相关知识知晓的影响因素分析。结果 广州市医疗机构放射诊断工作人员职业健康管理相关知识总知晓率为78.56%。知晓现从事岗位患者和受检者以及工作人员个人防护用品配置的分别为0.44%和33.04%,放射工作人员职业健康管理知晓率为79.65%～99.12%。logistic回归分析发现,广州市放射诊断工作人员职业健康管理相关知识知晓的促进因素为放射工龄（OR = 1.068）、市级医疗机构（OR = 7.733）、从不担心电离辐射对自身健康影响（OR = 4.764）和自觉现在工作环境辐射安全（OR = 3.391）。结论 广州市医疗机构放射诊断工作人员职业健康总知晓率较低,个人防护用品配置知晓最为薄弱,应加强相关教育和培训。     

厦门市粉尘作业工人职业健康监护和尘肺病发病状况

目的了解厦门市粉尘作业职业健康监护工作和尘肺病发病特点。方法对2006—2010年职业卫生统计年报表和职业健康检查结果汇总资料以及2006年以前尘肺病诊断资料进行回顾性研究。结果 2010年厦门市197家接尘企业接尘人数的总接触率为10.42%,总实检率88.79%,不同规模接尘企业实检率构成的差异有统计学意义（P〈0.01）;2006—2010年粉尘作业人员实检率均大于80%,检出率在0.99%～2.54%之间。尘肺病是该市主要的职业病,发病平均工龄和年龄明显缩短,病种主要是矽肺和电焊工尘肺。结论该市已建立了较规范的粉尘作业职业健康监护体系。尘肺病仍是该市主要的职业病,中、小型企业尘肺病发病形势严峻,发病年龄趋于年轻化、发病工龄明显缩短。     

Value Dimensions,Meaning, and Complexity in Human Occupation - A Tentative Structure for Analysis

In occupational therapy and occupational science, it is important to clarify the perspective from which the analysis of occupation is addressed. The purpose of this paper is to present a tentative structure for describing occupation, allowing for analysis in a lifelong panorama as well as for the immediate experience a person acquires from performing a single occupation. The concept of occupational value is introduced as a prerequisite for meaning, defining three different dimensions: concrete, symbolic, and self-reward value. A dynamic categorisation of single occupations is presented, considering each unique occupational performance viewed from a macro, meso, and a micro perspective, inspired by dynamic systems theory. It is proposed that all occupations are meaningful if they are integrated parts of a person's occupational continuity, and that it is the interaction between the mentioned three perspectives that determines their meaningfulness. With an explicit focus on value and meaning as perceived by the unique person, occupational therapists will become more skilled in designing meaningful occupational therapy interventions. This paper is a contribution to the development of occupational science as well as to occupational therapy, but the theoretical framework presented must be empirically tested in order to demonstrate its validity.     

Non-malignant occupational respiratory diseases in Germany in comparison with those of other countries

Objective: To present recent data on the occurrence of non-malignant occupational airway diseases in Germany and to compare mainly affected occupations of obstructive airway diseases caused by allergens and irritants with available surveillance data from other countries. Methods: Sources of German data were statistics for the year 2003 of the Ministry of Labour and Social Affairs and of the federation of statutory accident insurance institutions for the industrial sector. Results: Confirmed cases of non-malignant occupational respiratory diseases in Germany are mainly benign asbestos-associated diseases (occupational disease no. 4103: 1,975 cases), silicosis/coal workers pneumoconiosis (occupational disease no. 4101: 1,158 cases), obstructive airway diseases due to allergens (occupational disease no. 4301: 935 cases), chronic obstructive bronchitis and/or emphysema in hard coal miners (occupational disease no. 4111: 414 cases), obstructive airway diseases due to irritants and toxic agents (occupational disease no. 4302: 181 cases), diseases caused by ionising radiation (171 cases), diseases due to isocyanates (occupational disease no. 1315: 55 cases), and 22 cases of other rare occupational lung and airway diseases. Miners, bakers, chemical workers, hairdressers and health care workers are mostly affected. Bakers were also frequently affected by occupational asthma in Finland, France, Sweden, the United Kingdom, the Piedmont region in Italy, South Africa, and New Zealand. Further, high frequencies of occupational asthma were reported for health care workers in France, Italy, New Jersey, Michigan, and South Africa. Conclusion: Despite completely different legal definitions and regulations, comparably high numbers of occupational obstructive diseases in western countries require better primary and secondary prevention in industries with high incidence, especially in bakeries, the health care sector, farming, and mining. Furthermore, there is a urgent need for harmonization of recognition and compensation systems for occupational diseases as well as of respective preventive strategies within the European Union.     

Neuromusculoskeletal conditions of the upper extremity: are they due to repetitive occupational trauma?

The significance of neuromusculoskeletal conditions in the workplace is the subject of much discussion among occupational medicine professionals. There are differing philosophies as to what constitutes appropriate diagnostic criteria for identification of these conditions. The traditional diagnostic model requires the presence of objective pathology. An emerging symptom-based model accepts that symptoms by themselves can constitute a diagnostic entity. The extent to which these conditions are considered to be associated with occupational activity depends greatly upon which of the two models is employed. This chapter presents an overview of each diagnostic model and a discussion of the impact each has on the prevalence of identified conditions and the manner in which the various diagnostic requirements can affect treatment, prevention, and disability rating protocols.