Reactions of asbestos-exposed workers to notification and screening

In the wake of efforts to pass legislation mandating notification of workers at high risk of developing occupational disease, considerable controversy exists regarding the potential costs and benefits of such notification efforts. It has been suggested that individual notification would cause undue psychological distress, especially when primary prevention efforts are no longer possible. In this study, we assessed reactions of asbestos-exposed workers to a letter notifying them of their risk for asbestos-related illnesses and the availability of a medical screening program. Two hundred forty-seven workers who attended the screening program and 53 who chose not to attend completed a questionnaire that tapped reactions to notification. Workers reported neither undue psychological distress nor avoidance behavior in response to notification, and many respondents reported engaging in active and appropriate coping behaviors. Workers who first learned of their risk through the notification letter (33.7%) were no more likely to report distress or denial than were workers who had learned previously through other sources. Individuals who chose not to attend the screening program were less likely than attenders to report experiencing distress upon learning of their risk status, more likely to engage in minimization of risk, and less likely to have taken direct action. Our results suggest that the psychological costs of notifying workers of increased risk for asbestos-related illness appear to be outweighed by the benefits of notification and screening.     

Respiratory health in Turkish asbestos cement workers: the role of environmental exposure

AIM: Benign and malignant pleural and lung diseases due to environmental asbestos exposure constitute an important health problem in Turkey. The country has widespread natural deposits of asbestos in rural parts of central and eastern regions. Few data exists about the respiratory health effects of occupational asbestos exposure in Turkey. A cross-sectional study was conducted to investigate respiratory health effects of occupational asbestos exposure and the contribution of environmental asbestos exposure. METHODS: Investigations included asbestos dust measurements in the workplace and application of an interviewer-administered questionnaire, a standard posteroanterior chest X-ray and spirometry. Information on birthplace of the workers was obtained in 406 workers and used to identify environmental exposure to asbestos, through a map of geographic locations with known asbestos exposure. RESULTS: Asbestos dust concentration in the ambient air of the work sites (fiber/ml) ranged between 0.2 and 0.76 (mean: 0.25, median: 0.22). Environmental exposure to asbestos was determined in 24.4% of the workers. After the adjustment for age, smoking, occupational asbestos exposure, and potential risk factors environmental asbestos exposure was associated with small irregular opacities grade > or = 1/0 (44.2% vs. 26.6%, P < 0.01), FVC% (97.8 vs. 104.5, P < 0.0001), and FEV1% (92.4 vs. 99.9, P < .0001). Occupational exposure to asbestos was associated with small irregular opacities grade > or = 1/0 (OR: 2.0, 95% CI: 1.3-3.1, per 1 unit increase in the natural logarithm of fiber/ml) and FEV1/FVC% (beta: 1.1, SEM: 0.54; P < 0.05, per 1 unit increase in the natural logarithm of fiber/ml). CONCLUSIONS: Environmental exposure to asbestos could increase the risk of asbestosis and lung function impairment in workers occupationally exposed to asbestos, independent from occupational exposure and smoking.     

接触职业有害因素工人精神症状自评量表调查

目的:了解接触职业有害因素工人心理健康状况。方法:采用精神症状自评量表 (SCL-90)对接触职业有害因素工人进行心理健康状况测定。结果:躯体化症状因子平均分高于国 家常模且有显著性差异(P<0.01),其余均低于国家常模(P<0.01或P<0.05)。在不同性别、不同 年龄段阳性症状有差别。结论:职业有害因素对不同年龄段工人心理健康有不同影响。     

Past exposure to asbestos among active railroad workers

Before the transition from steam- to diesel-powered locomotives during the 1950s certain railroad workers had the opportunity for significant occupational exposure to asbestos. Past studies have demonstrated that older workers with jobs associated with the repair of steam locomotives had the most exposure. To determine the prevalence of currently employed railroad workers with past asbestos exposure we surveyed 514 white male employees of an active US railroad by mail questionnaire. Twenty-one percent (50/242) of the workers 50 years old or greater had likely asbestos exposure compared to 3% (9/275) of the workers 49 years old or less (p less than .001). Fifteen (30%) of the 50 older workers with likely asbestos exposure had current job titles no longer suggestive of past exposure. The duration of exposure of these older active workers was short, (median = 3 years; range, 6 months to 15 years). A history of past asbestos exposure may still be obtained among active railroad workers with past railroad shop employment.     

医务人员血源性病原体职业暴露调查

目的了解医务人员发生血源性病原体职业暴露的特点和危险因素,探讨防治对策。方法采用回顾性调查方法,运用《医务人员血源性职业暴露登记表》对某院2013年1月1日—2015年12月31日发生的血源性病原体职业暴露事件进行调查分析。结果共发生血液/体液职业暴露246例。职业暴露人群以在职护士为主(95例,占38.62%);职业暴露发生地点主要为病房(148例,60.16%);职业暴露方式以锐器伤为主(219例,占89.02%);医务人员发生职业暴露时的操作环节主要为手术意外(69例,占28.05%);暴露源主要为乙型肝炎病毒(HBV),共123例(占50.00%);暴露医务人员经局部处理和预防用药后,无1例发生感染。结论医疗机构应加强医务人员血源性病原体职业暴露相关培训,提高防护意识,规范操作行为,改善工作环境,最大限度地减少职业暴露的发生。     

Reaction time of industrial workers exposed to organic solvents: Relationship to degree of exposure and psychological performance

Auditory reaction time (RT) was examined on a day free from work and on a working day in 54 workers exposed to organic solvents and in 28 unexposed workers. Medical and occupational history was recorded and neurological examination and psychological testing carried out to establish quantitative parameters of exposure and cerebral function. There was a wider 95% range of the RT in the exposed group compared to the control group on the working day and a tendency in the same direction on the day free from work. There was no difference in the means of the RT, or within the groups between the examinations on the two days. The increased RT 95% range is interpreted as indicating an impaired ability in the exposed workers to maintain their attention during the experimental period, owing to chronic exposure of organic solvents. RT measurements did not correlate with exposure or psychological performance. RT would seem to be a means of measuring subclinical effects of exposure to organic solvents.     

医务人员血源性职业暴露调查及其对策

目的了解医务人员职业暴露现状,分析发生原因及危险因素,为采取有效防护措施提供依据。方法采用回顾性调查方法,对某院2013年1月1日—2016年12月31日发生的职业暴露事件进行调查分析。结果该院共发生职业暴露632例次。职业暴露发生以护士为主,共392例次,占62.02%;主要发生于工作年限不满2年的医务人员,共387例次,占61.23%。医务人员发生职业暴露的时机居前三位的分别是在输液完毕拔针、集中处置使用过的锐器物及针头以及手术缝合时,分别占15.19%、14.71%和12.18%。导致锐器伤发生的器械中,头皮钢针所占比例最大,共137例次,占23.42%;其次是缝合针,96例次,占16.41%。职业暴露血源性病原体以乙型肝炎病毒为主,占58.86%,其次是未知暴露源导致的职业暴露,占18.04%;职业暴露地点主要发生在普通病房(38.61%)。结论应加强职业安全防护教育,提高医务人员预防职业危害的能力,规范具有潜在危险的操作行为,加强医疗废物分类与管理,从而降低医务人员职业暴露所带来的危害。     

某院医务人员职业暴露监测

目的了解医务人员发生职业暴露人群的分布特征、危险因素与风险环节。方法对某院所有医务人员2011年1月—2014年6月发生的职业暴露进行风险监控,分别从发生职业暴露者的职业类别,暴露的地点、环节以及方式进行数据统计。结果 286例次职业暴露者中,男性63例(22.03%),女性223例(77.97%);2011年111例次(38.81%),2012年75例次(26.22%),2013年67例次(23.43%),2014年1—6月份33例次(11.54%);对不同人群发生职业暴露者统计数据显示,各年度不同人群发生职业暴露所占百分比相似,由高到低依次为护士(31.97)%、医师(19.90%)、护工(15.79%)、技师(7.64%)、护师(4.17%)和保洁员(2.84%);整理废物、拔针或更换针头、丢弃锐器入利器盒、手术缝合或器械传递、各种穿刺(含抽血)操作时的锐器伤是医务人员发生职业暴露损伤的主要风险环节,其构成比分别为22.38%、19.58%、14.34%、12.94%和11.19%;各年度职业暴露发生地点相似,主要是病房、手术室和注射(治疗)室,其构成比分别为51.40%、19.58%和11.54%。结论医院应建立完善的职业暴露监控与风险管理体系,强化标准预防,加强对职业暴露高危人群的培训,对风险环节及危险因素进行监控和干预,以有效降低医务人员职业暴露发生率。     

中国医务人员职业暴露与防护工作的调查分析

目的了解医务人员职业暴露与防护工作现状,为制定职业暴露防护措施提供依据。方法采用分层抽样方法于2016年4月6日—5月6日向全国13个省份158所不同级别医院发放调查问卷进行调查,分别调查各所医院开展职业暴露监测首年、2010年及2015年的职业暴露与防护管理及监测情况。结果81.65%（129/158）的医院医务人员职业暴露管理工作由医院感染管理部门负责;98.73%（156/158）的医院制定了相关规章制度;77.22%（122/158）的医院存在医务人员职业暴露漏报现象。共发生职业暴露事件11 116例,调查首年发生1 542例,2010年发生2 474例,2015年发生7 100例。锐器伤在各类职业暴露类型中占96.76%;职业暴露人员职业分布中,护理人员占53.90%;职业暴露人员科室来源主要为普通病房、手术室、重症监护病房等;引起医务人员职业暴露器具主要为注射器、头皮钢针、手术缝针等;静脉注射、针头丢入利器盒、手术缝针等是引起医务人员职业暴露的高危操作;在职业暴露源阳性分布中,以乙型肝炎病毒（HBV）为主,占58.69%。结论我国医务人员面临职业暴露的风险大,危害重,形势严峻,应通过政府立法、推广应用安全器具、规范医务人员操作行为、正确使用个人防护用品、强化医务人员教育与培训、建立健全职业暴露报告、评估和随访机制等措施,以切实减少职业暴露的发生。     

某三甲中医院医务人员针灸针职业暴露调查

目的 调查分析医务人员针灸针职业暴露发生现状及原因。方法 采用自制问卷回顾性调查某三甲中医院涉及针灸针操作的27个临床科室医务人员3年内发生针灸针职业暴露相关情况,并进行比较与分析。结果 本次调查1 585名医务人员中共有164名发生231次针灸针职业暴露,发生率为10.35%。不同年龄、工作年限、职业类别的医务人员职业暴露发生率比较,差异均具有统计学意义(均P<0.001),发生针灸针职业暴露的主要为学员(包括实习生、进修生及规培生)、<25岁、工作年限1年以内的医务人员。231次针灸针锐器伤涉及的针具主要为毫针(106次,45.88%);刺伤环节主要是拔针过程中(68次,29.44%);暴露场所主要是病房(82次,35.50%)。按原则规范处理的176次,占76.19%,及时上报148次,上报率为64.07%。结论 中医医院医务人员针灸针职业暴露发生率较高,应加强学员、新进员工的职业防护培训及考核,规范针具使用过程中的操作行为,进一步预防及降低医务人员针灸针职业暴露的发生。     

健康教育对住院患者心理健康的影响

目的 探讨护理健康教育对住院患者心理健康的影响.方法 选择接受过心理护理课程和护理健康教育课程培训的护理人员,对患者实施心理护理和护理健康教育.结果 患者在接受心理护理和健康教育培训前、后心理因子分比较(t=4.135、4.012,均P＜0.01),有显著性差异.结论 护理健康教育能有效改善患者的心理状况,对患者心理因子分的改变有显著统计学差异,患者对医院的满意度有显著性差异.     

Facilitator report: Bloodborne pathogens exposure among health care workers

Several psychosocial and organizational factors have been identified as important correlates of compliance with safe work practices among health care workers. In particular, compliance with “universal precautions”—a set of work practices which were designed to minimize exposure to bloodborne pathogens—has been found to be associated with several potentially modifiable factors. The development of interventional strategies designed specifically to target these factors (e.g., HIV/AIDS attitudes, safety climate) are important objectives in the overall risk management approach to occupational exposure to bloodborne pathogens. © 1996 Wiley-Liss, Inc.     

Evaluating the readability and suitability of construction occupational safety and health materials designed for workers

Introduction

Printed materials for training and hazard communication are an essential part of occupational safety and health programs, but must be understood by their intended audience.

Methods

Researchers collected 103 safety training handouts, brochures, and Safety Data Sheets and scored them for readability and suitability using four standard health communication instruments: the SMOG test, the Flesch‐Kincaid Reading Ease Assessment, the SAM (Suitability Assessment of Materials), and CCI (the CDC Clear Communication Index).

Results

Some of the materials used unfamiliar and technical terms. The SAM and CCI checklists revealed several elements of design and layout known to facilitate communication and comprehension, but missing from most of the materials scored.

Conclusion

Occupational safety and health professionals preparing curricula and handouts for distribution to workers should incorporate some form of readability and suitability assessment to help ensure their written materials are clear and comprehensible to all segments of their audience.

     

丙型肝炎病毒职业暴露处理与追踪随访

目的了解临床医务人员发生丙型肝炎病毒(HCV)职业暴露后处理过程及感染情况,为HCV职业暴露的防护提供经验。方法调查5例发生HCV职业暴露医务人员的暴露环节、暴露后处理方法及追踪随访结果。结果5例发生HCV职业暴露的医务人员均为临床护士,1例确诊为职业暴露后急性感染HCV。发生HCV暴露后,均给予常规心理支持和咨询,4例排除感染者很快恢复正常的工作和生活;确诊被感染者暂时调离临床一线岗位,加强心理支持,坚持完成1年聚乙二醇干扰素联合利巴韦林的抗病毒治疗后痊愈。结论医务人员发生HCV职业暴露后及时上报、进行HCV RNA感染监测;确诊感染HCV后尽早联合聚乙二醇干扰素及利巴韦林抗病毒治疗,是治愈HCV急性感染的关键措施。     

Asbestos exposure: A potential cause of retroperitoneal fibrosis

The etiology of retroperitoneal fibrosis is unknown in 70% of the cases. The aim of our study was to examine the possible association between occupational asbestos exposure and retroperitoneal fibrosis; only two cases have been reported in the literature. We gathered all the cases of retroperitoneal fibrosis diagnosed in the Tampere University Hospital between 1987 and 1995. We examined their hospital records to evaluate the possible etiology of the disease. We also sent a structured questionnaire to all living patients (10/13) to obtain information on their asbestos exposure. The chest radiographs of the patients were re-read to evaluate possible changes resulting from asbestos exposure. We found 13 cases of idiopathic retroperitoneal fibrosis. Seven patients (all male) had been exposed to asbestos in the past. The chest radiographs of the four most-exposed patients showed characteristic asbestos-related abnormalities, including bilateral pleural plaques, round atelectasis and small irregular lung opacities. In our study, we found that asbestos exposure and asbestos-induced changes in the lung and pleura were common among male retroperitoneal fibrosis patients. We suggest that occupational exposure to asbestos may be an important etiological factor for retroperitoneal fibrosis. Am. J. Ind. Med. 33:418–421, 1998. © 1998 Wiley-Liss, Inc.     

Chlorophenol exposure in harbor workers exposed to river silt aerosols

OBJECTIVES: While dredging the river Elbe in the harbor of Hamburg, workers are potentially exposed to river silt aerosols containing organic compounds. The aim of this cross-sectional study was to determine the internal load of chlorophenols in exposed workers. METHODS: Eighty-four exposed workers and eighty-four unexposed office workers were examined. Urinary samples were analyzed for dichlorophenols, trichlorophenols, tetrachlorophenols, and pentachlorophenol (PCP). RESULTS: For exposed workers, more than 2/3 of the urinary samples were above detection limit for 2,5-dichlorophenol, 2,4/3,4-dichlorophenol, 2,4,6-trichlorophenol, and PCP. Harbor workers had significantly higher median levels of 2,5-dichlorophenol (0.6 vs. 0.4 microg/g creatinine) and PCP (1.4 vs. 1.0 microg/g creatinine) as compared to unexposed subjects. These differences remained statistically significant after adjustment for age, smoking habits, and fish consumption. CONCLUSION: Harbor workers in the harbor of Hamburg have a statistically significant higher internal load of chlorophenols than the general population. However, the internal load is within the range of exposure reported from the general population. Therefore, even though chlorophenols are found in the river silt these exposures do not seem to be the major source of the internal load among workers in the harbor of Hamburg.     

职业性噪声对暴露人群健康效应初步分析

目的分析工业作业场所职业性噪声对暴露人群的健康效应。方法于2005年随机抽取南方某市部分噪声暴露工厂,按《作业场所噪声测量规范》(WS/T69-1996)进行测点选择和测量噪声强度[dB(A)],按照《职业健康监护管理办法》对其职业性噪声暴露人群进行健康检查,并对4家产生稳态噪声、4家产生脉冲噪声的工厂的暴露人群的健康效应进行比较分析。结果共对84家工厂的1374个噪声作业点进行噪声强度测定,噪声平均强度83.40[dB(A)],作业点噪声强度90[dB(A)]以上占23.22%(319/1374),85~89[dB(A)]占25.47%(350/1374),85[dB(A)]以下占51.31%(705/1374),超标率为48.69%(699/1374);7464例噪声暴露工人的健康检查结果显示,听力损伤检出率为20.47%(1528/7464),心电图异常检出率7.32%(546/7464),心率异常检出率为3.93%(293/7464),血压偏高检出率为3.71%(277/7464);稳态噪声和脉冲噪声的平均强度分别为84.96、88.49[dB(A)],两者的等效噪音强度差异无统计学意义(P>0.05);脉冲噪声暴露人群的听力损伤、血压偏高检出率均高于稳态噪声的(P>0.01)。暴露人群的听力损伤检出率与暴露水平存在正相关关系(rs=0.952 4,P<0.01)。结论职业性噪声暴露对人群健康效应的影响表现为脉冲噪声对噪声暴露者的危害比稳态噪声大;噪声强度和噪声暴露者的听力损伤检出率存在剂量反应关系。     

某三级综合医院医务人员职业暴露调查

目的了解某三级综合医院医务人员职业暴露情况,分析职业暴露发生原因及预防对策。方法对某院2010年1月—2013年12月134例发生职业暴露的医务人员进行调查。结果暴露人群中,护士所占比率最高(59.70%),其次是医生(19.40%)、医技人员(9.70%)。职业暴露主要原因为锐器管理不规范(占46.27%,62例),其次为操作意外(占42.54%,57例)、防护措施不足所致(占11.19%,15例);暴露方式以锐器伤为主(占94.78%,127例),黏膜接触暴露占5.22%(7例),暴露源不明确者占42.54%,暴露源明确者占57.46%,其中乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)、梅毒螺旋体(TP)、人类免疫缺陷病毒(HIV)分别占35.82%、12.69%、3.73%、2.24%;HBV、HCV合并感染占2.24%(3例);HIV、HBV、HCV、TP合并感染占0.74%(1例)。职业暴露后正确处理率为95.52%。结论护士是职业暴露高危群体,做好职业防护,并规范锐器管理,可以减少医务人员职业暴露发生。