Neurobehavioural effects of occupational exposure to cadmium: a cross sectional epidemiological study

BACKGROUND—A patient with unexplained minor behavioural changes associated with an axonal sensorimotor polyneuropathy had a history of chronic occupational exposure to cadmium (Cd). Although animal studies have shown that Cd is a potent neurotoxicant, little is known about its toxicity for the human central nervous system. The aim of this study was to investigate the toxic potential of chronic occupational exposure to Cd on neurobehavioural functions.
METHODS—A cross sectional epidemiological study was conducted in a group of Cd workers and an age matched control group. Eighty nine adult men (42 exposed to Cd and 47 control workers) were given a blinded standardised examination that consisted of computer assisted neurobehavioural tests (neurobehavioural examination system), a validated questionnaire to assess neurotoxic complaints (neurotoxicity symptom checklist-60, NSC-60), and a standardised self administered questionnaire to detect complaints consistent with peripheral neuropathy and dysfunction of the autonomic nervous system. Historical and current data on biomonitoring of exposure to Cd, either the highest value of Cd in urine (CdU in µg Cd/g creatinine) of each Cd worker during work (CdU_max) or the current value (CdU_current) of each control, were available as well as data on microproteinuria.
RESULTS—Cd workers (CdU_max: mean (range), 12.6 (0.4-38.4)) performed worse than the controls (CdU_current: mean (range), 0.7 (0.1-2.0)) on visuomotor tasks, symbol digit substitution (p=0.008), and simple reaction time to direction (p=0.058) or location (p=0.042) of a stimulus. In multiple linear regression analysis, symbol digit substitution, simple direction reaction time test, and simple location reaction time test were significantly related to CdU_max, (β=0.35 ( p<0.001), β= 0.25 (p=0.012), and β=0.23 (p=0.021) respectively). More complaints consistent with peripheral neuropathy (p=0.004), complaints about equilibrium (p=0.015), and complaints about concentration ability (p=0.053) were found in the group exposed to Cd than in the control group, and these variables correlated positively with CdU_max (peripheral neuropathy: β=0.38, p<0.001; equilibrium: β=0.22, p=0.057; concentration ability: β=0.27, p=0.020).
CONCLUSION—Slowing of visuomotor functioning on neurobehavioural testing and increase in complaints consistent with peripheral neuropathy, complaints about equilibrium, and complaints about concentration ability were dose dependently associated with CdU. Age, exposure to other neurotoxicants, or status of renal function could not explain these findings. The present study also indicates that an excess of complaints may be detected in Cd workers before signs of microproteinuria induced by Cd occur.


Keywords: cadmium; neurotoxicity; occupational exposure     

三氯乙烯作业人群外周血淋巴细胞染色体损伤研究

目的探讨三氯乙烯(TCE)致作业人群外周血淋巴细胞染色体损伤的作用。方法以91名TCE暴露工人和59名对照作为研究对象,调查职业史、年龄、性别、吸烟和饮酒等信息。收集班后尿,测定尿中三氯乙酸(TCA)水平反映TCE暴露内剂量。抽取肘静脉血,胞质分裂阻滞微核法制备外周血淋巴细胞涂片,计数微核、核质桥和核芽发生率,评价染色体损伤水平。结果两组研究对象在年龄、性别、吸烟、饮酒状况等方面均无显著性差异。暴露组平均TCE作业工龄为1.8年。暴露组尿中TCA水平为57.5mg/L,远远高于对照组0.9mg/L。两组研究对象的微核率及核质桥率无显著差异,但暴露组核芽率[(1.6±1.0)‰]显著高于对照组[(1.2±0.8)‰,P=0.05]。核芽率的升高在尿TCA≥50.0 mg/L组和TCE作业工龄≥1.8年组中表现更为明显。同时,尿TCA≥50.0 mg/L的工人,其微核率[(1.8±0.9)‰]也显著高于对照组[(1.4±0.7)‰,P=0.05]。未发现年龄、性别、吸烟、饮酒对微核率、核质桥率、核芽率的显著影响。结论 TCE暴露可致作业工人染色体损伤增加,核芽可以较为敏感的检出由TCE职业暴露所引发的基因组不稳定性。     

Impact of stigma,culture and law on healthcare providers after occupational exposure to HIV and hepatitis C

Worldwide, approximately three million needlestick or sharps injuries occur annually during healthcare procedures, with an estimated 18–35 healthcare professionals (HCPs) acquiring HIV each year as a result. This qualitative study examined the lived experience of occupational exposure to HIV or hepatitis C reported by four HCPs working in a tertiary care hospital in United Arab Emirates (UAE). Findings were based on interviews conducted as part of a larger two-year study investigating an intervention to improve the reporting and management of blood and body fluid exposures (BBFE) in the hospital. The data showed that due to cultural differences, individuals exposed to the same disease within the same legal system could have different concerns. Five themes arose from the data: (1) experiencing the unexpected, (2) inevitability and finality, (3) impact of stigma, (4) responsibility and risk and (5) legal and financial implications. The participants' most important concerns and causes of stress arising from occupational BBFE were related to the social implications (i.e., stigma; legal and financial costs) rather than the biological consequences of the disease. Social implications like these may negatively impact on reporting of occupational BBFE in UAE, but may need to be addressed at a societal rather than organisational level.     

Case-control study on occupational exposure to diesel exhaust and lung cancer risk.

The association between lung cancer and occupations with probable exposure to diesel exhaust (DE) was studied among 2,584 cases and 5,099 hospital controls. The crude odds ratio (OR) for probable exposure was 1.31 (95% confidence interval [CI] 1.09-1.57), but adjustment for smoking and other confounders reduced the estimate to 0.95 (95% CI = 0.78-1.16). Similar results were observed for truck drivers, the only occupational category large enough for separate analysis. Data on self-reported exposure for 477 cases and 946 controls revealed a crude OR of 1.45 (95% CI = 0.93-2.27), which was reduced to 1.21 (95% CI = 0.78-2.02) after controlling for smoking and other confounders. The present results and a review of the literature do not definitively support an etiologic association between DE exposure and elevated lung cancer risk.     

医务人员血源性职业暴露与防护措施的KAP现况研究

目的了解某院医务人员职业暴露与防护知识、态度和行为现状,并调查影响戴手套及穿隔离衣的原因。方法对2012年10月16日该院在岗的部分临床医务人员进行问卷调查。结果共调查医务人员374名,全院平均每人参加培训（1.47±1.54）次,内科医务人员参加培训次数为（2.00±2.12）次,高于其他科室 (均P＜0.001)。硕士以上学历和医生的知识水平得分分别为（88.43±11.09）分、（88.14±11.48）分,均较高。在态度、行为方面,不同组别医务人员间差异均无统计学意义(均P＞0.05)。影响医务人员戴手套和穿隔离衣的主要原因分别是影响操作和配备不足。结论该院医务人员职业暴露与防控知识水平、态度和行为均不理想;医院应采取措施,提高医务人员职业暴露防护水平。     

Bio-monitoring of DNA damage in matchstick industry workers from Peshawar Khyber Pakhtunkhwa,Pakistan

Background: Safety protocols are usually neglected in most of the matchstick industries rendering the laborer prone to various occupational hazards.

Objective: The present study highlights DNA damage among matchstick factory workers (n = 92) against a control group (n = 48) of healthy individuals.

Methods: Genotoxicity was measured in peripheral blood lymphocytes of the test subjects using a Single Cell Gel Electrophoresis assay (SCGE/comet assay).

Results: Our results substantiate a high Total Comet Score (TCS) for factory workers (74.5 ± 47.0) when compared to the control group (53.0 ± 25.0) (P ≤ 0.001). Age and duration of occupational exposure had no significant effect (P > 0.05) on TCS value. As for job function, the TCS value was greatest in sweepers (91.0 ± 56.1) and lowest in box-making operators (26.0 ± 25.0) indicating that waste disposal poses the higher risk of DNA damage.

Conclusions: Our study corroborates that matchstick chemicals can potentially damage the DNA of exposed subjects.     

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。     

Analysis of Pesticide Exposure and DNA Damage in Immigrant Farmworkers

ABSTRACT

In the last decade, the Comet assay has been used increasingly in studies of workers potentially exposed to genotoxic substances in the workplace or environment. Significant increases in DNA damage measured with the Comet assay has been reported in lymphocytes of agricultural workers; however, less intrusive means of biomonitoring are needed in epidemiological investigations. This study was designed to use the Comet assay to describe the association of markers of DNA damage in oral leukocytes with biomarkers of pesticide exposure in 134 farmworkers working in berry crops in Oregon compared to control populations. The authors also examined the extent of DNA damage in young workers compared to adults and the effect of work histories, lifestyle factors, and diet on markers of DNA damage. Urinary levels of organophosphate pesticides were low at the time of sampling; however, mean levels of the Captan metabolite tetrahydrophthalimide (THPI) were found to be shifted significantly higher in the farmworkers (0.14 μg/ml) compared to controls (0.078 μg/ml) (one-sided p value?=?.01). Likewise, the combined molar equivalent of all dialkylphosphate metabolites was marginally higher in farmworkers (p value?=?.05). The mean tail intensity was significantly greater for agricultural workers compared to controls (one-sided p value?<.001), indicating more DNA damage in the oral leukocytes. On average, the mean tail intensity was 10.9 units greater for agricultural workers (95%?CI: 6–16 units greater). Tail moment was also significantly greater for agricultural workers compared to nonagricultural workers (one-sided p value?<.001). No Comet parameter was significantly associated with years spent working in agriculture, age, sex, body mass index, diet, and alcohol or tobacco use. The results of this study demonstrate the feasibility for using the Comet assay in biomonitoring studies of farmworkers. Additional studies are needed to examine the effects of different pesticide types on DNA damage and to capture the temporal relationship between exposure to agricultural chemicals and changes in Comet parameters.     

2013－2016年南京市民膳食中镉暴露风险评估

目的 了解南京市居民主要膳食消费量及市售食品中镉含量,对居民通过膳食镉暴露健康风险进行初步评估。 方法 2013－2016年监测全市10大类共计1 181份样品镉含量,结合2012年南京市居民膳食消费量调查,应用食品中化学污染物膳食暴露点评估法,初步评估南京市居民主要食品的镉暴露风险。 结果 市售食品中镉含量较高的食品是茶叶、面粉、菌藻类、水产品和动物内脏, 镉含量的中位数分别为:0.0300、0.0249、0.0203、0.0285、0.0327 mg/kg;各类蔬菜中叶菜类平均镉含量最高(中位数为0.0100 mg/kg),镉含量最低的食品是新鲜水果(0.0003 mg/kg)和畜肉(0.0024 mg/kg)。居民平均每月膳食镉暴露量为0.0087 mg/(kg·bw),占每月可耐受摄入量的34.6%;膳食摄入量采用P₅₀时,膳食中镉的每月暴露量为0.0027 mg/(kg·bw),占每月可耐受摄入量的10.8%,膳食摄入量采用P₉₀时,膳食中镉的每月暴露量为0.0188 mg/kg·bw,占PTWI的75.0%。大米、菌藻类、蔬菜和水产品是镉摄入的主要来源,从粮谷类食品、蔬菜、水产品中摄入的镉分别占膳食镉暴露量(膳食摄入量采用P₉₀时)的35.91%、13.98%、19.10%。居民膳食中每月镉暴露量均值占PTMI百分数的顺序依次为6~17岁年龄组(45.3%)、18~44岁年龄组(36.0%)、45~60岁年龄组(34.4%)和60岁以上年龄组(32.2%)。 结论 南京市居民膳食镉暴露水平总体安全,但仍有必要加强食品中镉含量监测,从源头上控制镉污染,进而减少居民膳食中镉暴露水平。     

职业接触灭蚁药物对人体淋巴细胞DNA的损伤作用

[目的]探讨职业性接触灭蚁药物氯丹、含砷化合物对作业人员外周血淋巴细胞DNA损伤水平的影响。 [方法]采用碱性单细胞凝胶电泳技术检测灭蚁药物作业工人外周血淋巴细胞的DNA损伤,研究灭蚁药物对职业接触人群的遗传毒性,观察指标包括DNA断裂分级(将DNA断裂损伤细胞按其损伤程度分级)及DNA彗星尾长(彗头末端到彗尾的长度)。并对工龄、吸烟、饮酒和体内毒物的浓度对外周血淋巴细胞DNA损伤水平各项指标的影响进行统计学分析。[结果]职业接触灭蚁药物工人外周血淋巴细胞DNA断裂程度及DNA彗星尾长两个指标,均明显高于对照组,差异有显著性(P<0．01),并与体内毒物水平、接触工龄有明显正相关关系,吸烟、饮酒能加重含氯丹、砷化合物对DNA的损伤水平。[结论] 职业性接触灭蚁药物可对职业工人外周血淋巴细胞DNA造成损伤,并存在遗传毒性。     

Shared occupational risks for transitional cell cancer of the bladder and renal pelvis among men and women in Sweden

BACKGROUND: Unlike cancer of the bladder, cancer of the renal pelvis is not considered an occupational cancer and little is known about risks among women. METHODS: Using the Swedish national census and cancer registry-linked data (1971-1989), we identified transitional cell cancers of the renal pelvis (N = 1,374) and bladder (N = 21,591). Correlation between cancer sites for the standardized incidence ratios (SIR) were determined using Pearson's coefficient of the log SIR. Relative risks of job exposure matrix variables were calculated using Poisson regression. RESULTS: Both cancer sites were significantly elevated among women and men employed in the machine/electronics industry, sedentary work, and indoor work, and men in the metal industry. The highest proportion of the bladder (12%) and renal pelvis (14%) cancers occurred among men employed in shop and construction metal work. Risks by industry were more correlated among women (r = 0.49, P = 0.002) than men (r = 0.24, P = 0.04). Cancers of the renal pelvis were elevated in several occupational and industry groups for which there was no elevated bladder cancer risk. CONCLUSION: Cancers of the renal pelvis and bladder share common occupational risk factors that may be more frequent among women. In addition, there may be some jobs that pose an increased risk specifically for cancer of the renal pelvis but not bladder.     

准医护人员艾滋病职业暴露认知及羞辱与歧视

目的 了解准医护人员对艾滋病相关职业暴露的认知与恐惧心理以及羞辱和歧视现象,为进一步在准医护人员中开展艾滋病宣传教育提供科学依据。方法 采用自行设计调查问卷,随机抽取湖南省湘南学院343名准医护人员进行问卷调查。结果 343名准医护人员对艾滋病职业暴露相关知识的总知晓率为72.5%,其中男生为71.0%,女生为73.2%,不同性别知晓率差异无统计学意义(P>0.05);仅6.4%的准医护人员对与艾滋病感染者日常接触各项假设均不惧怕,女生恐惧心理高于男生(t=3.77,P<0.01);男女生对艾滋病感染者相关羞辱感差异无统计学意义(P>0.05);准医护人员中愿意为艾滋病感染者进行手外伤包扎者占35.6%,视情况而定者占60.3%,拒绝处理者占4.1%;认为艾滋病感染者或患者只能到传染病院就医者占83.4%,不愿意为HIV阳性患者做体格检查者占6.9%,会将患者感染HIV的情况告诉其他与治疗无关的同事者占22.2%,在接诊艾滋病感染者或患者时感到紧张与恐惧者占60.1%,认为不应向艾滋病感染者或患者提供就业机会者占23.6%。结论 准医护人员对日常接触艾滋病职业暴露相关知识知晓率不高,对艾滋病职业暴露存在恐惧心理,艾滋病相关羞辱感与歧视感较为严重。     

农村基层妇产科工作人员职业暴露及有关因素的调查报告

目的 了解农村基层妇产科工作人员在工作中职业暴露——意外针刺和污染物溅人眼鼻口——的发生情况及有关因素。方法 采用半结构式同卷对安徽省两个县的县级和乡镇级卫生机构妇产科所有在岗工作人员进行横断面调查。结果 在137名调查对象中．在工作中发生过由针头或其它锐利器具引起的意外刺伤的人数为78，占57％；在工作中发生过让病人分泌物意外溅人眼鼻口的人数是90，占66％。发生过刺伤或粘膜暴露的人数是107，占78％。在职业暴露的5条补救措施中．选出2条以上的人数是41人．占31％。绝大多数人报告工作场所内没有防护眼镜(93％)．也有不少人报告工作场所没有盛废弃锐利器具的专用垃圾桶(27％)。讨论和结论 基层妇产科工作人员职业暴露情况严重．存在一定的职业危险。提出5条措施降低卫生人员职业暴露危险。     

医务人员艾滋病职业暴露防护知识调查

目的 了解湖北省襄樊市襄城城区和乡镇医务人员艾滋病职业暴露和防护知识的知晓情况,为加强预防职业暴露工作提供依据。方法 对149名城区和167名乡镇医务人员进行艾滋病职业暴露及防护知识问卷调查。结果 医务人员对艾滋病职业暴露及防护知识的知晓率不高。城区和乡镇医务人员在防护和暴露后应急处理知识方面差异有统计学意义。结论 需要加强医务人员的艾滋病防治和职业暴露防护知识培训,医疗机构要建立和完善职业暴露的检查和处理机制,提高医务人员的防护意识和暴露后应急处理能力,减少艾滋病职业暴露的风险。     

单细胞凝胶电泳法检测苯作业工人淋巴细胞DNA损伤

目的 用碱性单细胞凝胶电泳技术检测苯作业工人外周血淋巴细胞DNA损伤,研究苯的遗传毒性。方法 采用碱性单细胞凝胶电泳技术。将接苯工人按累积浓度、历史平均浓度和测定当时8h时间加权平均浓度（8hTWA）分组。观察指标包括DNA断裂分级（将DNA断裂损伤细胞按其损伤程度分级）及DNA彗星尾长（彗头末端到彗尾的长度）。结果 接苯工人DNA断裂程度及DNA彗星尾长[Ig(尾长＋1）]两个参数,接苯组按累积浓度、历史平均浓度和8hTWA浓度计算,均明显高于对照组,差异有显著性（P＜0．01）,并有明显的剂量－反应关系。结论 彗星试验能够快速,敏感地检测苯引起的人类淋巴细胞DNA损伤,提示对于检测环境致癌物和致突变物可能是一有用工具。     

Relation of radon exposure and tobacco use to lung cancer among tin miners in Yunnan Province, China

We studied the relation of radon exposure and tobacco use to lung cancer among tin miners in Yunnan Province in the People's Republic of China. Interviews were conducted in 1985 with 107 living tin miners with lung cancer and an equal number of age-matched controls from among tin miners without lung cancer to obtain information on lung cancer risk factors including a detailed history of employment and tobacco use. Occupational history was combined with extensive industrial hygiene data to estimate cumulative working level months (WLM) of radon daughter exposure. Similar data were also used to estimate arsenic exposure for control in the analysis. Results indicate an increased risk of lung cancer for water pipe smoking, a traditional form of tobacco use practiced in 91% of cases and 85% of controls. Ever use of water pipes was associated with a twofold elevation in risk when compared with tobacco abstainers, and a dose-response relation was observed with increasing categories of pipe-year (dose times duration) usage. Estimated WLM of radon exposure varied from 0 to 1,761 among subjects but averaged 515 in cases versus only 244 in controls. Analyses indicated that the persons in the highest quarter of the radon exposure distribution had an odds ratio (OR) = 9.5 (95% confidence interval = 2.7-33.1) compared to persons without radon exposure after controlling for arsenic exposure and other potential confounders. Examination of duration and rate of radon exposure indicated higher risk associated with long duration as opposed to high rate of exposure. Cross-categorizations of radon exposure and tobacco use suggest greater risk associated with radon exposure than tobacco in these workers.     

医务人员职业暴露现状调查及对策

目的了解医务人员职业暴露现状和特点,为制定预防对策提供依据。方法自行设计职业暴露问卷调查表,调查2015年1—12月全院医务人员职业暴露情况,并进行统计分析。结果调查1 888名工作人员,发生职业暴露共304例,全院平均职业暴露发生率为16.10%;发生职业暴露370例次,职业暴露例次率为19.60%。医生、进修实习人员和工作年限≤1年的工作人员职业暴露相对较高,分别为23.18%(102/440)、17.88%(49/274)、18.34%(95/518)。锐器伤为主要的职业暴露方式,占83.24%(308例),发生环节以器械使用后处理前、器械使用中为主,分别占37.99%(117例)和36.69%(113例)。370例次职业暴露中,可追溯到暴露源的有315例次。已知暴露源中,血源性病原体职业暴露占24.13%(76例次)。370例次职业暴露中,仅59例次实施了完整的局部处理和上报程序,职业暴露上报率为15.95%。结论该院应采取综合措施最大程度地促进职业安全防护,降低职业暴露发生率。