189例尘肺病合并肺结核情况分析

目的研究尘肺病患者合并肺结核的感染现状,降低尘肺病病人结核病的发生率。方法收集2020—2021年在湖南省职业病防治院住院治疗的尘肺病合并肺结核的189例病例进行调查。结果尘肺病合并肺结核的合并率为2.43%(189/7785)。尘肺病合并肺结核的病种包括煤工尘肺、矽肺、混合尘肺、水泥尘肺共4种,以煤工尘肺和矽肺为主,分别占56.6%和40.7%。合并肺结核的发病年龄为(58.31±9.08)岁,煤工尘肺合并肺结核病例的发病年龄高于矽肺合并肺结核病例(P<0.05)。尘肺病合并肺结核的病例中,壹期、贰期、叁期的合并率依次为1.00%、1.89%、3.56%,随着期别增加而上升(P<0.05)。煤工尘肺合并肺结核病例利福平耐药率为10.28%(11/107),矽肺则为11.68%(9/77),其余尘肺病患者利福平耐药率为0,三者差异无统计学意义(P>0.05)。结论尘肺病合并肺结核以煤工尘肺和矽肺最常见,对合并率影响最主要的因素是尘肺病期别。各种尘肺病合并肺结核病例对利福平的耐药率接近。     

阳泉市1 230例尘肺合并肺结核特征分析

目的探讨尘肺合并肺结核的危害,分析了解其预后和寻求防治对策。方法对1 230例尘肺合并结核病人进行了回顾性调查分析。结果阳泉市累计尘肺病发病共计5 149例(Ⅰ期3 155例,Ⅱ期1 546例,Ⅲ期448例);合并结核患者1 230例,占23.89%,尘肺期别越高,结核合并率越高;矽肺合并结核晋期率高于单纯矽肺,煤工尘肺合并结核晋期率也高于单纯煤工尘肺,尘肺合并结核病死率随尘肺期别增高而增大;尘肺合并结核及其死亡与尘肺患者的工种有关,掘进工结核合并率最高,采矿工合并结核病死率最高,经统计学检验,均有显著性差异(P<0.01)。结论对接尘工人和尘肺病人进行防痨工作,及早发现结核,是降低尘肺合并结核率,保护尘肺患者健康的重要手段。     

重庆市某国有煤矿煤工尘肺合并肺结核的情况

目的了解重庆市某国有煤矿煤工尘肺合并肺结核的患病情况,为煤工尘肺结核患者的疾病预防和管理工作提供依据。方法对重庆市某国有煤矿自1976—2007年间829例煤工尘肺病例合并结核的情况进行分析。结果重庆市某国有煤矿1976—2007年间煤工尘肺合并结核率为8.20%,显著高于当地人群的肺结核患病率,差异具有统计学意义（χ2=114.03,P〈0.01）。煤工尘肺合并结核率随着期别增加而显著增高（χ趋2势=5.23,P〈0.05）。采煤、掘进、混合3个工种尘肺合并结核率分别为6.08%、6.60%、16.89%,其中混合工种尘肺合并结核率明显高于两个单纯工种,差异具有统计学意义（P〈0.01）。煤工尘肺合并结核率随发病年龄升高而升高（χ趋2势=30.71,P〈0.01）,煤工尘肺合并结核率随工龄升高无明显改变,差异无统计学意义（x趋2势=2.22,P〉0.05）。煤工尘肺合并肺结核患者死亡率为6.15%,死因构成比：肺心病占31.37%,肺结核占23.53%,肺癌占19.61%,肺部感染占15.69%,其他疾病为9.80%。结论尘肺期别越高,煤工尘肺合并结核率越高;混合工种煤工尘肺合并结核率明显高于两个单纯工种;煤工尘肺合并结核的死因前三位是肺心病、肺结核大咳血和肺癌。     

淮北矿区煤工尘肺结核发病特点和危险因素及防治策略

目的 了解煤工尘肺合并肺结核的流行状况及发病特点并提出尘肺结核的防治策略.方法 用回顾性流行病学调查方法对淮北矿业集团1963年1月-2009年12月确诊的1019例尘肺合并肺结核情况进行调查分析.结果 (1)煤工尘肺合并肺结核的发病率为17.93％;(2)煤工尘肺合并结核与尘肺期别呈正相关,随着尘肺期别增加,结核合并率亦增加;(3)煤工尘肺合并肺结核后使尘肺晋期率显著升高,平均晋期时间显著缩短,随着尘肺期别的增加,尘肺结核合并率、病死率升高,尘肺结核合并率随入矿年代的增加而降低;(4)影响煤工尘肺结核的因素有尘肺期别、工种、接尘工龄、入矿年代等.结论 煤工尘肺易并发肺结核,肺结核是导致尘肺病人死亡的主要原因之一,尘肺合并结核后使病情进展很快,病死率高,因此应加强尘肺结核的预防控制.     

阳泉市尘肺病流行病学调查

目的为了降低尘肺病的发病率,探讨尘肺病对职工的危害,分析了解其预后和寻求防治对策。方法对阳泉市1963~2002年诊断的5 149例尘肺病患者进行回顾性调查分析。结果阳泉市累计尘肺病发病5 149例,Ⅰ期为3 155例,Ⅱ期为1 546例,Ⅲ期为448例;尘肺种类排序前三位为煤工尘肺占54.26%,矽肺41.23%,铸工尘肺3.26%;尘肺合并结核率随期别增高而增加,Ⅰ期为19.81%,Ⅱ期为25.42%,Ⅲ期为47.10%,经统计学检验有显著性差异(P<0.01);矽肺与煤工尘肺的平均发病工龄分别为17.14年、24.34年,经统计学检验,二者有高度显著性差异(P<0.01),有2 030例尘肺患者死亡,病死率为39.43%,死亡原因肺部疾患列第一,各种癌症列第二。结论尘肺病患病的期别与合并结核关系密切,矽肺的危害要大于煤工尘肺的危害,尘肺病患者由于肺部疾患引起的肺功能障碍导致死亡占死因的第一位,为了延长尘肺病人寿命,要对尘肺病人进行定期体检,增强尘肺病人的抵抗力,以保护患者的身体健康。     

煤工尘肺合并肺结核的死因分析

目的探讨煤工尘肺合并肺结核的死亡原因及发病规律。方法煤工尘肺及肺结核诊断:1986年前符合1963年相关尘肺X射线诊断标准,1986年至2001年符合1986年GB 5906—1986《尘肺X线诊断标准及处理原则》,2002年后符合GBZ 70—2002《尘肺病诊断标准》;统计学处理采用SPSS 12.0软件对资料进行分析。结果煤工尘肺患者1 712例,死亡病例853例;煤工尘肺合并肺结核489例(其中死亡358例),年龄(53.3±7.9)岁。煤工尘肺合并肺结核频率为28.56%,而煤工尘肺不同期别合并肺结核有差异,Ⅰ、Ⅲ期煤工尘肺合并肺结核频率高,并与Ⅱ期煤工尘肺合并肺结核率差异有显著性(2=51.36,P<0.005),煤工尘肺合并肺结核直接死因中以肺结核恶化病死率最高(39.47%),直接死于煤工尘肺为12.88%,肺心病4.09%,肺癌3.48%,最低为胃癌、喉癌和高血压0.20%。结论肺结核是煤工尘肺主要合并症,也是煤工尘肺患者合并肺结核主要死亡原因(39.47%);煤工尘肺合并肺心病(4.09%)、肺癌(3.48%)等合并症病死率亦较高,也是煤工尘肺合并肺结核患者主要死亡原因之一。     

义马某煤业集团煤工尘肺医疗费的调查

目的调查义马某煤业集团煤工尘肺的医疗费发生情况,为保障尘肺患者及时治疗合理使用医疗费提供依据。方法由职业卫生专职人员和劳资社保人员分别对该单位煤工尘肺病人的基本情况和2006年发生的医疗费进行调查、登记、统计。结果煤工尘肺病人年龄最小55岁,最大79岁,平均65岁;111例煤工尘肺病人共发生医疗费522 300元,人均(4 705±672)元;Ⅰ期尘肺病人发生的平均医疗费明显低于Ⅰ期尘肺合并活动性肺结核病人的平均医疗费(P<0.05),也明显低于Ⅱ期尘肺病人发生的平均医疗费(P<0.01),Ⅰ期尘肺合并活动性肺结核病人发生的平均医疗费和Ⅱ期尘肺病人发生的平均医疗费差异无统计学意义(P>0.05)。结论要重点作好高期别尘肺病人和合并活动性肺结核尘肺病人的医疗救治工作,同时要做好工伤社会保险费的缴纳工作。     

2008年广西尘肺病流行病学调查分析

目的 了解广西2008年尘肺病发生、发展的特点以及流行特征.方法 对广西2008年诊断的133例尘肺病例进行流行病学调查分析.结果 2008年广西尘肺发病Ⅰ期90例,Ⅱ期34例,Ⅲ期9例;以矽肺(90.23%)和煤工尘肺(7.52%)为主.尘肺并发结核率高(21.05%)、晋期时间短、接尘工龄短.尘肺病的工业系统主要分布在有色金属矿采选业(65.41%),其次为黑色金属矿采选业(14.29%)和煤炭采选业(6.77%).工种以风钻工、爆破工和掘进工为主.尘肺病人主要分布在南宁、柳州和河池3市.结论 广西尘肺病防治工作仍然严峻,需加强对矿山开采业的尘肺病防治工作,同时加强对农民工进行尘肺病防治知识的宣传和职业健康检查.     

职业医学

060046 矽肺并发呼吸道感染者痰培养及药敏试验结果分析；060047 煤工尘肺患者血清白细胞介素6及其可溶性受体含量的变化；060048 转化生长因子β1在个旧矿工肺癌和其他地区肺癌中表达的比较研究；060049 煤工尘肺病人围手术期处理的探讨（附106例报告）；060050 某乡镇精密铸造行业发生多例矽肺病的调查分析。     

郑州市1963～2003年煤工尘肺流行病学调查

为了摸清郑州市煤工尘肺分布现状、发病规律和死亡原因,建立全市尘肺病例数据库,为制定尘肺防治对策提供科学依据。我们按照全国统一方案制定的“尘肺病例卡”上的项目,对郑州市1963~2003年全部煤工尘肺病例的各项变量统一编码,建立数据库,进行统计分析。结果表明,煤工尘肺累计病例3 745例,主要分布在巩义市、郑州市矿务局和新密市,共占全市煤工尘肺病例的77.14%;煤工尘肺Ⅰ期2 392例,占全市煤工尘肺总数的63.87%,Ⅱ期1 304例(34.82%),Ⅲ期49例(1.31%);平均发病年龄为46.0岁,平均发病工龄为21.9 a,肺结核的并发率为11.6%,全市煤工尘肺累计死亡228例,病死率为6.09%,主要死于慢性呼吸系统疾病。建议,进一步加大卫生监督执法力度,增强监管能力,有效控制和预防尘肺病的发生。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

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.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

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.