Using a representative sample of workers for constructing the SUMEX French general population based job-exposure matrix

Background: Job-exposure matrices (JEMs) applicable to the general population are usually constructed by using only the expertise of specialists. Aims: To construct a population based JEM for chemical agents from data based on a sample of French workers for surveillance purposes. Methods: The SUMEX job-exposure matrix was constructed from data collected via a cross-sectional survey of a sample of French workers representative of the main economic sectors through the SUMER-94 survey: 1205 occupational physicians questioned 48 156 workers, and inventoried exposure to 102 chemicals. The companies'' economic activities and the workers'' occupations were coded according to the official French nomenclatures. A segmentation method was used to construct job groups that were homogeneous for exposure prevalence to chemical agents. The matrix was constructed in two stages: consolidation of occupations according to exposure prevalence; and establishment of exposure indices based on individual data from all the subjects in the sample. Results: An agent specific matrix could be constructed for 80 of the chemicals. The quality of the classification obtained for each was variable: globally, the performance of the method was better for less specific and therefore more easy to assess agents, and for exposures specific to certain occupations. Conclusions: Software has been developed to enable the SUMEX matrix to be used by occupational physicians and other prevention professionals responsible for surveillance of the health of the workforce in France.     

Evaluation and revision of questionnaires for use among low-literacy immigrant Latinos

As more Spanish speaking immigrants participate in and become the focus of research studies, questions arise about the appropriateness of existing research tools. Questionnaires have often been adapted from English language instruments and tested among college-educated Hispanic-Americans. Little has been written regarding the testing and evaluation of research tools among less educated Latino immigrants. The purpose of this study was to evaluate and revise a battery of Spanish-language questionnaires for an intervention among immigrant Hispanic women. A three-step process was used to evaluate, adapt and test Spanish versions of the Self-Efficacy and Exercise Habits Survey, an abbreviated version of the Hispanic Stress Inventory-Immigrant version and the Latina Values Scale. The revised tools demonstrated acceptable validity and reliability. The adaptations improved the readability of the tools, resulting in a higher response rate, less missing data and fewer extreme responses. Psychometric limitations to the adaptation of Likert scales are discussed.     

Study of the validity of a job-exposure matrix for psychosocial work factors: results from the national French SUMER survey

Objective  To construct and evaluate the validity of a job-exposure matrix (JEM) for psychosocial work factors defined by Karasek’s model using national representative data of the French working population. Methods  National sample of 24,486 men and women who filled in the Job Content Questionnaire (JCQ) by Karasek measuring the scores of psychological demands, decision latitude, and social support (individual scores) in 2003 (response rate 96.5%). Median values of the three scores in the total sample of men and women were used to define high demands, low latitude, and low support (individual binary exposures). Job title was defined by both occupation and economic activity that were coded using detailed national classifications (PCS and NAF/NACE). Two JEM measures were calculated from the individual scores of demands, latitude and support for each job title: JEM scores (mean of the individual score) and JEM binary exposures (JEM score dichotomized at the median). Results  The analysis of the variance of the individual scores of demands, latitude, and support explained by occupations and economic activities, of the correlation and agreement between individual measures and JEM measures, and of the sensitivity and specificity of JEM exposures, as well as the study of the associations with self-reported health showed a low validity of JEM measures for psychological demands and social support, and a relatively higher validity for decision latitude compared with individual measures. Conclusion  Job-exposure matrix measure for decision latitude might be used as a complementary exposure assessment. Further research is needed to evaluate the validity of JEM for psychosocial work factors.     

Development of a job exposure matrix for the epidemiological follow-up of workers in the French nuclear industry

BACKGROUND: A pilot study was carried out in the AREVA NC Pierrelatte nuclear facility in order to investigate a possible carcinogenic effect of internal radiation exposure among nuclear workers in France. The objective of this study was to develop a method for retrospective reconstruction of the occupational exposure to internal radiation from uranium and associated chemical exposures. METHODS: A plant- and period-specific job exposure matrix (JEM) was designed. Job groups and exposure agents groups including uranium compounds and other chemical agents known as being carcinogenic, mutagenic or toxic were defined by an expert committee. Exposure was evaluated by active and retired workers included in the evaluator committee. A quantitative assignment of quantity and frequency of handling (both coded from 0 to 3) was performed for each agent groups using a method derived from the Delphi technique. RESULTS: In all, 23 experts and 353 evaluators participated to the JEM elaboration. A final JEM involved 232 "job-periods" presenting throughout the plant period 1960-2006 and 22 exposure agents groups in use at the plant. Six of them involved uranium compounds classified by their blood-transferability and toxicity characteristics. A first validation of the JEM by experts in radiological protection and industrial hygiene showed an acceptable internal consistency. CONCLUSION: In the context of missing past exposure measurement data, the plant- and period-specific job exposure matrices may be considered as a valid alternative for exposure estimation. This method may be applied to other nuclear plants and offers allowance to investigate a possible carcinogenic effect of internal radiation exposure among nuclear workers.     

Use of a job-exposure matrix for the screening of occupational exposure to asbestos

BACKGROUND: According to a recent French legislation (1995), retired people who have been exposed to an occupational carcinogen can benefit from a specific post-occupational medical follow-up program, supported by the "Caisse Primaire d'Assurance-Maladie" (CPAM), the French health insurance system. However, only very few people presently take access to this social measure. The ESPACES project developed and evaluated a procedure to identify retirees who have been exposed to asbestos during their career, and to inform them about the post-occupational medical follow-up program. METHODS: This pilot study was performed within the health centers ("Centres d'examens de santé" (CES)) of the health insurance system in a random sample of men who have retired from the six main French administrative divisions between 1994 to 1996. A probability of exposure to asbestos was attributed through a job exposure matrix. Subjects were interviewed in the CES to validate their exposure data. Retired subjects with confirmed exposure to asbestos were referred to their CPAM, to apply for the medical follow-up. The whole process was evaluated through a comparison with control CPAMs, and simulations were performed to assess its sensitivity and specificity, as well as the total number of persons in France who could potentially benefit. RESULTS: Among the 737 persons classified as exposed by the matrix who came to the CES, the exposure was confirmed for 53.8%, and 143 benefited from the medical follow-up, 17 times more than in a sample of control CPAMs. Based on an annual number of about 250,000 new retirees, simulations showed that a low detection threshold, taking into account the probability and duration of exposure, would yield approximately 25,000 persons coming to the CES, more 6,000 of them benefiting from the follow-up. CONCLUSION: The proposed detection threshold would allow for a feasible and ethically acceptable generalization, due to the optimization of the false negative and false positive rate.     

Developing a general population job-exposure matrix in the absence of sufficient exposure monitoring data

In New Zealand, there is a need for a comprehensive and accessible database with national occupational exposure information, such as a general population job-exposure matrix (GPJEM). However, few New Zealand-specific exposure data exist that could be used to construct such a GPJEM. Here, we present the methods used to develop a GPJEM for New Zealand (NZJEM), by combining GPJEMs from other countries with New Zealand-specific exposure information, using wood dust as an example to illustrate this process. The assessments of GPJEMs from other countries were made available to a New Zealand expert in occupational wood dust exposure, who then provided a preliminary NZJEM assessment (including the percentage exposed and the level of exposure for each occupation). Where possible, this assessment was based on New Zealand exposure measurements. In the next step, information from a nationwide workplace exposure survey of 3000 members of the New Zealand workforce was used to finalize the NZJEM assessments. The final NZJEM listed 104 of the 956 New Zealand occupational codes as exposed to wood dust. The percentage of workers exposed within an occupation ranged from 5% (e.g. boiler attendants) to 100% (e.g. cabinet makers). The level of exposure ranged from 0.05 mg m(-3) (e.g. electricians) to 3 mg m(-3) (e.g. carpenters). Of these assessments, 23% were mainly based on New Zealand exposure data, 37% on overseas GPJEMs and exposure data, and for 40% the national survey data served as the main source of information for the expert assessment. Combining the NZJEM assessments with national employment statistics indicated that 5.6% of the New Zealand workforce is occupationally exposed to wood dust, corresponding to a total of 97 000 workers (86% male and 14% female). Construction-related occupations included the largest number of exposed workers.     

北京地区16个病种的疾病与手术分类质量评估

目的 评估疾病分类与手术分类的编码质量,为按病种付费的DRGs研究提供依据.方法 从北京市23所医院2003年至2004年16个病种的病案及计算机数据库中,各医院抽样100册,要求各医院填写病案摘录卡,由编码专家组对出现的问题进行讲解与培训.在此基础上,医院重新填写病案摘录卡,专家组再抽样5%共9 730册病案进行审查.结果 100册病案的抽样显示,错误率在50%以上;经培训后的5%的抽样显示,主要疾病诊断错误率为2.01%,全部疾病诊断的错误率为17.04%,主要手术操作的错误率为2.49%,总错误率为22.74%.结论 DRGs研究必须重视基础数据质量,而病案摘录卡可作为DRGs研究的重要手段.要加强培训,尽量减少错误编码.     

Linking expert judgement and trends in occupational exposure into a job-exposure matrix for historical exposure to asbestos in the Netherlands

The aim of this article was to describe the structure and content of a job-exposure matrix (JEM) for historical asbestos exposure in The Netherlands. The JEM contained 309 occupational job title groups in 70 branches of industry during 10 periods of 5 years during 1945-1994, resulting in 3090 evaluations. Dutch sources on asbestos exposure measurements provided quantitative guidance for 69 evaluations (2.2%) in 25 occupational title groups. In addition, three databases from the UK Health and Safety Executive contributed to 222 evaluations (7.2%) and several other sources aided in another 133 evaluations (4.3%). These evaluations resulted in seven categories of exposure levels for all 3090 combinations of occupational title groups and periods. A verification process with five experts was used to adjust the assignments of exposure categories. The trends in exposure patterns over time were described in relation to production activities, operational control measures and the presence of dust control measures. For the majority of asbestos-related diseases in the past decades, reliable information on their historical exposure patterns was lacking. The limited availability of exposure measurements in the past illustrates the need for a structured assessment of historical asbestos exposure through a JEM.     

2008—2013年河南省艾滋病患者抗病毒治疗对HIV的抑制效果及其影响因素分析

目的了解上海市静安区HIV感染者抗病毒治疗的依从性现状及相关因素,分析管理模式对治疗依从性的影响。方法将2015—2016年“小组关怀管理模式”组的感染者(150例)和未参加管理模式的对照组感染者(150例)中已接受抗病毒治疗者(共221例)作为研究对象,分别收集其一般情况、生活行为方式、抗病毒治疗依从性、生活质量、社会支持、心理状况和医学应对等信息,采用线性回归分析治疗依从性的相关因素。结果纳入研究的221例HIV感染者中,模式组124例,对照组97例。治疗依从性良好的比例为86.0%,模式组和对照组分别为91.9%和78.4%。多因素分析显示,治疗依从性的相关因素为管理模式(β=1.871,P < 0.001)、每月可支配收入(β=0.600,P=0.001)、社会支持利用度(β=0.174,P=0.044)和屈服的医学应对态度(β=-0.153,P=0.003)。结论静安区HIV感染者抗病毒治疗依从性有待进一步提高。“小组关怀管理模式”能有效促进感染者治疗依从性的提高,但这一管理模式应从覆盖人数和内容方式两方面进一步改进和完善。     

A study of job stress among women and men in the Federal Republic of Germany

A study was designed to test the association between job demandsand job decision latitude and coronary heart disease (CHD) riskand psychological strain among working men and women in theFRG. The data are from the 1984 FRG national health survey.The sample used for this research was composed of 795 persons:476 working men and 319 working women. Following the work ofKarasek, the results indicate that psychological strain wasrelated to high job demands and low job decision latitude. However,an association between CHD risk and high job demands and lowjob decision latitude was not supported by the findings. Correlationalanalyses revealed moderate correlations between psychologicalstrain and CHD risk. Multiple regression analyses indicatedthat low decision latitude may be a stressor that grows moresevere in the presence of high job demands in terms of negativehealth outcomes. Significant differences between men and womenwere also found.     

Evaluation of moderate alcohol use and cognitive function among men using a Mendelian randomization design in the Guangzhou biobank cohort study

Observational studies usually show that moderate alcohol use is associated with better cognitive function. Such studies are vulnerable to residual confounding arising from systematic differences between moderate alcohol users and others. A Mendelian randomization study carried out in a suitable population, such as southern Chinese men, in which alcohol use is low to moderate and is influenced by genotype, offers an alternative and superior approach for clarifying the causal effect of moderate alcohol use on cognitive function. The authors used aldehyde dehydrogenase 2 (ALDH2) genotype (AA, GA, or GG) as an instrumental variable in 2-stage least squares analysis to obtain unbiased estimates of the relation of alcohol consumption (measured in alcohol units (10 g ethanol) per day) with cognitive function, assessed from delayed 10-word recall score (n = 4,707) and Mini-Mental State Examination (MMSE) score (n = 2,284), among men from the Guangzhou Biobank Cohort Study (2003-2008). ALHD2 genotype was strongly associated with alcohol consumption, with an F statistic of 71.0 in 2-stage least squares analysis. Alcohol consumption was not associated with delayed 10-word recall score (-0.03 words per alcohol unit, 95% confidence interval: -0.18, 0.13) or MMSE score (0.06 points per alcohol unit, 95% confidence interval: -0.22, 0.34). Moderate alcohol use is unlikely to be cognitively protective.     

某医院护理人员工作满意度调查分析

目的 了解护理人员工作满意度现状及影响护理人员工作满意度的因素,为管理者提高护士工作满意度和工作积极性提供参考依据.方法 应用自行设计调查问卷对某院随机抽取的200名护士进行调查,收回有效问卷198份.结果 护士对自己工作总体满意度不高,对工作报酬满意度最低;不同学历、年龄、护龄、婚姻状况的护士工作满意度不同.结论 应根据影响工作满意度因素及护士需求,采取不同的管理措施及激励手段,提高工作满意度.     

Comparison of asbestos exposure assessments by next-of-kin respondents, by an occupational hygienist, and by a job-exposure matrix from the National Occupational Hazard Survey

BACKGROUND: Assessments of occupational exposures in case-control studies of rapidly fatal illnesses often rely on data from next-of-kin respondents, which may be inaccurate. METHODS: Three methods for assessing exposure to asbestos from case-control data on mesothelioma, including next-of-kin assessment, expert assessment, and use of a generic job-exposure matrix (JEM). Interview data [Spirtas et al. (1994): Occup Environ Med 51:804-811] were reviewed to determine exposure status by an occupational hygienist (C.R.) who was unaware of disease status. Exposure odds ratios were calculated using standard methods, and measures of agreement included the kappa statistic and conditional and marginal odds ratios. RESULTS: Expert assessment detected higher proportions of exposed subjects than the next-of-kin respondents or JEM methods. The disease-exposure odds ratios were highest for respondents, perhaps because of recall bias, and lowest for the JEM method. The agreement was highest between the respondent and expert assessments. A combination of respondent's assessment and JEM assessment led to the best prediction of the expert's assessment. Results for spouse respondents were similar to those for other "next-of-kin" respondents. CONCLUSIONS: Expert assessments were the most plausible, but the data indicate that disease associations could also be detected with the other exposure assessment methods. Using some combination of the proxy respondent's assessment and the JEM assessment, one can predict the expert's assessment. A strategy that relied on the respondent's assessment when it was positive and otherwise obtained an expert assessment could reduce costs with little error, compared to expert assessment on all subjects.     

应用中国孕期膳食平衡指数评价成都市孕妇膳食质量

目的建立中国孕期膳食平衡指数(DBI-P)并评价成都市孕妇膳食质量及变化,为孕妇营养干预提供依据。方法依据孕妇平衡膳食原则和中国孕妇DRIs(2013),在中国成人DBI基础上,建立中国孕期膳食平衡指数(DBI-P);采用24 h膳食回顾法对成都市610名健康孕妇进行追踪调查,收集孕早、中、晚期各类食物摄入量,利用DBI-P评价和分析其各孕期整体膳食质量及变化。结果孕妇各孕期水果、蛋类摄入量达到推荐量,畜禽肉类摄入量高于推荐量,而谷类、蔬菜、奶类、大豆及坚果类和水产品类摄入量低于推荐量。孕妇各孕期水果达标率较高(59.0%~79.0%),其他类食物达标率均较低(5.7%~48.4%),以谷类最低(5.7%~7.4%)。孕妇各孕期DBI-P总分(中位数)均小于0,提示膳食总体水平趋向于摄入不足;孕早、中、晚各期正端分(中位数)分别为3、4和4,提示轻微摄入过量,过量程度在各孕期相同(P0.05),摄入过量比例分别为21.0%、33.1%和24.1%;负端分(中位数)分别为24、19和21,提示低度摄入不足,不足程度在孕早期最高(P0.017),摄入不足比例分别为96.1%、88.0%和91.3%;膳食质量距(中位数)分别为27、23和25,提示整体膳食质量存在中~低度摄入不均衡,不均衡程度在孕早期最高(P0.017),摄入不均衡比例分别为97.9%、96.9%、97.4%。结论成都市孕妇膳食摄入不均衡,以孕早期较突出,以摄入不足为主。     

Comparability of nutrient estimation by three food frequency questionnaires for use in epidemiological studies

Replication of results is an important issue in studies of diet and disease, possibly dependent on data collection method. We compared assessments from the Health Habits and History Questionnaire (HHHQ), the Harvard Semiquantitative Food Frequency Questionnaire (HFFQ), and the New York State Cohort Food Frequency Questionnaire (CFFQ) for estimates of daily intakes of energy, protein, carbohydrates, total fat, dietary fiber, cholesterol, vitamins A, C, and E, and carotenoids. Fifty-nine men and 50 women aged 35-73 years completed the HHHQ and HFFQ as interviews and the 44-food CFFQ as a self-administered mailed questionnaire. Comparability was assessed with Spearman correlation coefficients. Quantitation of nutrient intake differed by nutrient, questionnaire, and nutrient calculation method. Ranking on energy and macronutrient intake for the HHHQ and HFFQ ranged from 0.62 to 0.80; ranking for micronutrient intake ranged from 0.56 to 0.80. For the CFFQ with the HHHQ or HFFQ, correlations ranged between 0.29 and 0.62. The CFFQ performs comparably to the HHHQ and HFFQ for some, but not all, nutrients; our results suggest that the HHHQ and HFFQ can be used interchangeably with reasonable confidence in studies of diet and disease.     

Off-label use of the female condom for anal intercourse among men in New York City

We surveyed 111 male clients of an HIV/AIDS service organization in New York City in 2008 and 2009. Seventeen percent had used the female condom for anal intercourse; of these, 89.3% had used the female condom with male partners, 21.4% with female partners, and 10.7% with both. Users of the female condom for vaginal intercourse were more likely to use it for anal intercourse (odds ratio = 12.7; 95% confidence interval = 2.5, 64.9; P = .002). The safety and efficacy of the female condom for anal intercourse are unknown and should be evaluated.