金属加工液对工人肺通气功能的影响

目的探索接触金属加工液(metal working fluids,MWF)对工人肺通气功能的影响。方法对某机械加工车间工龄满1年的工人进行健康体检,并根据工作场所空气中MWF浓度对工人进行分组,≤1mg/m3者为低浓度组,>1mg/m3为高浓度组。利用logistic回归模型进行多因素分析,并利用比例风险模型计算肺通气功能异常影响因素的患病比(PR值)。结果高浓度组肺通气功能异常率为18.1%,低浓度组肺通气功能异常率为9.7%,差异有临界统计学意义(χ2=3.13,P=0.077)。logistic回归分析显示接触MWF的OR值为2.49(1.00~6.20),比例风险模型计算的患病比(PR值)为1.88(0.89~3.95)。结论 MWF暴露可能使肺通气功能异常率增加。应制定相应的标准和防治规范,使MWF的监测、监督和治理纳入目前的管理体系。     

某机械加工车间金属加工液污染情况调查及原因初探

选取某商用车发动机厂机械加工车间,进行职业卫生调查和空气中金属加工液浓度检测,探讨机械加工车间空气中金属加工液污染的现状及原因。结果显示,作业场所空气中金属加工液浓度为0.10～2.62 mg/m3,达标率仅为14.3%;经统计分析,设备密闭情况、通风情况对工作场所金属加工液影响具有统计学意义(P<0.05),而生产线、设备类型等因素对金属加工液影响则无统计学意义。表明某商用车发动机厂机械加工车间空气中金属加工液污染比较严重,建议采取切实可行的措施予以控制。     

接触木尘工人与脱尘工人肺功能的配对研究

为深入研究木尘对接尘工人肺功能的影响，我们按照配对设计原则，对某厂木型车间接触木尘工人与脱离木尘作业工人分别进行了肺通气功能的配对比较分析。结果表明，无论是接尘组工人，还是离尘组工人，其ＦＶＣ、ＦＥＶ１、ＭＭＦ、Ｖ５０与Ｖ２５等肺功能各项指标的实测值，均较对照组明显降低，且多具有显著的统计学意义。累计接尘量与肺功能各指标实测值／预计值百分比间存在着一定的剂量－反应关系，即随着累计接尘量增加肺功能损害加重。多因素分析显示：累计接尘量是致接尘工人肺功能下降的主要因素。提示接尘工人、脱离木尘作业工人肺通气功能的损害与木尘有关。     

2018年张家港市重点职业病监测电焊烟尘接触者肺功能异常情况分析

目的了解2018年张家港市重点职业病监测中电焊烟尘接触者呼吸异常情况及其影响因素,为预防和控制职业性肺功能异常提供理论依据。方法收集2018年张家港市重点职业病监测电焊烟尘接触者职业健康检查资料,分别按职工的年龄、工龄、性别以及企业规模、经济类型等因素进行统计分析。结果 2018年张家港市重点职业病监测电焊烟尘接触者健康检查4 385人,其中肺功能检查结果异常为922人,异常检出率为21.03%;职工的年龄、工龄、性别、企业规模、经济类型等不同因素下异常率比较,差异均有统计学意义(均P<0.05);肺功能异常检出率随着年龄的增长逐渐增高(P<0.05)。结论接触电焊烟尘对劳动者的肺功能有明显的影响,不同的年龄、工龄、企业规模、经济类型等因素下异常率关联水平存在一定的变化趋势。应采取有效的防护措施,针对不同规模、经济类型的企业制定相应的防治策略。     

谷物粉尘接触量与肺功能损害的剂量－反应关系研究

本文对沈阳市某粮库３１４名男性接尘工人和２２５名对照者进行了肺功能检测。结果显示，接尘组Ｖ－（７５）、Ｖ－（５０）和Ｖ－（２５）三项肺功能指标明显低于对照组，ＦＶＣ、ＦＥＶ－（１．０）改变不明显。逐步回归分析发现ＦＥＶ－（１．０）、Ｖ－（７５）、Ｖ－（５０）、Ｖ－（２５）与累计接尘量呈负相关，随累计接尘量增加，Ｖ－（７５）、Ｖ－（５０）和Ｖ－（２５）明显减低。应用寿命表方法分析了累计接尘量与肺功能Ｖ－（７５）、Ｖ－（５０）和Ｖ－（２５）三项指标累计异常率的关系，提出了生产环境空气中谷物粉尘容许浓度值。     

婴幼儿肺部感染后的肺功能变化及临床随访分析

目的 了解婴幼儿肺部感染后潮气肺功能变化及其主要影响因素,以及两年内再次呼吸道感染的发生情况。方法 选取2018年1月至12月于我院儿内科病房收治的234例普通肺炎患儿为研究对象。根据急性期(T0)潮气肺功能检测情况,将其分为肺功能正常组(n=90)和肺功能异常组(n=144);肺功能异常组分为喘息组(n=92)和非喘息组(n=52)、早产出生组(n=24)和足月出生组(n=120)。随访期为出院后1个月(T1)、6个月(T2)、12个月(T3)、24个月(T4)四个时期。结果 肺功能异常组和正常组分别有69例(47.92%)和28例(31.11%)患儿在两年内再次出现肺部感染,差异有统计学意义(χ²=6.445,P<0.05)。多因素Logistic分析显示,既往喘息、特应性体质家族史、本次喘息发作、过敏原阳性、二手烟暴露均为婴幼儿肺部感染后肺功能异常的危险因素(OR值分别为3.635、5.705、3.558、4.696、1.964,P<0.05)。早产出生组、足月出生组T1时达峰时间比(TPTEF/TE)、达峰容积比(VPEF/VE)、潮气量(TV...     

支气管肺发育不良患儿肺功能变化的动态随访研究

目的监测支气管肺发育不良(bronchopulmonary dysplasia,BPD)生后3年内潮气呼吸肺功能动态变化,以探讨BPD对患儿远期肺功能的影响。方法收集BPD患儿生后3年内临床资料及肺功能结果,与同龄非BPD患儿对比。结果 BPD患儿生后3年内均存在肺功能异常,肺功能参数如潮气量(VT)、吸气时间(TI)、达峰时间比(TPTEF/TE)、达峰容积比(VPTEF/VE)降低,呼吸频率(RR)、呼气时间(TE)升高,与非BPD患儿比较,差异有统计学意义(P0.05);身高及体重均较同龄非BPD儿童下降(P0.05)。结论 BPD导致婴儿肺功能异常,并影响生长发育。     

低浓度接触异氰酸酯作业人员呼出气一氧化氮和肺功能研究

目的 研究低浓度异氰酸酯接触对气道炎症水平和肺功能的影响,探讨呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)在接触异氰酸酯作业人员职业健康检查中的应用。方法 2016—2017年,选择接触异氰酸酯的192名作业工人为研究对象,另选不接触职业病危害因素的91名年龄、性别构成相近的办公、后勤人员作为对照组。收集人员基本信息和近5年作业场所空气中异氰酸酯检测结果,对研究对象行肺功能检查、FeNO测定和沙丁胺醇支气管舒张试验,比较不同特征人群的各项指标的差异。结果 近5年工作场所空气中异氰酸酯检测结果远低于国家职业卫生标准。接触组的用力肺活量(forced vital capacity,FVC)、第一秒用力呼气量(forced expiratory volume in first second,FEV₁)均高于对照组,FEV₁/FVC低于对照组,差异均有统计学意义(P<0.001)。接触组和对照组FeNO水平差异无统计学意义(P>0.05)。接触异氰酸酯<7年组FEV_l     

苯接触者及苯中毒者血小板参数变化研究

目的 分析苯职业接触进程中血小板参数变化规律.方法 对正常人群组(74人)、苯接触组(33人)、慢性苯中毒组(14人)进行血小板参数和其他周围血细胞计数分析.结果 血小板计数慢性苯中毒组、苯接触组分别和正常人群组比较,差异均有统计学意义(P＜0.05);苯接触组和正常人群组比较,差异无统计学意义(P＞0.05).血小板分布宽度慢性苯中毒组、苯接触组分别和正常人群组比较,差异均有统计学意义(P＜0.05);苯接触组和慢性苯中毒组比较,差异有统计学意义(P＜0.05).血小板平均体积慢性苯中毒组、苯接触组分别和正常人群组比较,差异均有统计学意义(P＜0.05);苯接触组和慢性苯中毒组比较,差异有统计学意义(P＜0.05).大血小板比率慢性苯中毒组、苯接触组分别与正常人群组比较,差异均有统计学意义(P＜0.05);慢性苯中毒组与苯接触组比较,差异无统计学意义(P＞0.05).结论 血小板参数在苯接触监测中具有潜在应用价值.     

尘肺病患者胸部螺旋CT影像与肺功能变化研究

目的 研究尘肺病患者胸部螺旋CT与肺功能变化的关系,探讨尘肺病患者肺损伤的评估方式。 方法 检查91例尘肺病患者胸部螺旋CT和肺功能,对胸部CT不同影像改变与肺功能变化结果进行比较分析。 结果 胸部螺旋CT表现为双肺肺野不同区域弥漫性分布的圆形小阴影、小阴影聚集和大阴影;75.82%的患者表现为不同程度的肺功能损伤,主要为限制性和混合性通气障碍以及弥散障碍;随着阴影分布扩大和聚集,肺功能损伤的异常率逐渐升高(P<0.05);大阴影组FEV₁、MVV、DL_CO与其他各组比较,VC、FVC、FEV₁/FVC、RV/TLC与上肺野、上中肺野小阴影分布组比较,以及小阴影聚集组DL_CO与上肺野、上中肺野小阴影分布组比较,差异均有统计学意义(P<0.05)。各组肺功能损伤类型和肺通气功能损伤类型差异无统计学意义(P>0.05)。 结论 胸部螺旋CT能在一定程度上反映尘肺病患者肺功能变化,但它和肺功能是评价尘肺病肺损伤的两种独立方法,不能相互替代,两者联合检查有助于尘肺病的病情观察和诊断鉴定。     

Microorganism-induced skin disease in workers exposed to metalworking fluids

BACKGROUND: An outbreak of skin disorders among workers potentially exposed to metalworking fluids prompted the present study. Few studies have described skin disorders associated with microbe-contaminated metalworking fluids. METHODS: Samples of materials contaminated with metalworking fluids were obtained from two manufacturing facilities in Ohio. Pathogenic bacteria and yeasts, in concentrations sufficient to cause skin disease, were cultured from 9 of 12 (75%) sampled materials. RESULTS: Allergic patch testing of five affected people produced negative results for standard allergens, augmented by fluids and items from their workplace. This ruled out allergies as the cause of the skin disease. Improper handling and disposal of cotton gloves, inappropriate use of scouring pads and ineffective hand wiping were apparently responsible for the microbiological contamination. The hands and forearms were most commonly affected. CONCLUSION: Improper handling of soluble, synthetic and semi-synthetic metalworking fluids provides an excellent environment for the growth of a range of microorganisms, including bacteria and fungi. If allowed to grow because of poor occupational hygiene, these microorganisms can cause skin disorders among workers. Soiled protective clothing (gloves, coveralls and work boots) should be cleaned or discarded on a regular basis. When washing up, workers should not use metalworking fluids and items used to clean machinery.     

Smoothing in survival models: an application to workers exposed to metalworking fluids

BACKGROUND In occupational epidemiology it is typically assumed that the relation between exposure, possibly transformed, and the risk of an adverse health outcome is linear in the parameters. Alternatively, exposure is transformed into a categorical variable.METHODS We used nonparametric regression to examine the linearity assumption for prostate and brain cancer mortality in a cohort of 46,400 autoworkers exposed to metalworking fluids. Using a nested case-control sample, we fit Cox proportional hazards models with penalized splines, in which we allowed the risk to be a smooth function of exposure to each of three types of metalworking fluids. Two dose metrics in addition to cumulative exposure were considered.RESULTS The shape of the dose-response curve for soluble metalworking fluids and each cancer was approximately piecewise linear, with a small increase in risk at lower exposures followed by a larger increase at exposures above a critical point.CONCLUSIONS This example illustrates that the penalized spline methodology can be easily applied to cohort studies to estimate smooth exposure-response curves.     

Cancer risks among workers exposed to metalworking fluids: A systematic review

Metalworking fluids (MWFs) are commonly used in a variety of industrial machining and grinding operations. The National Institute for Occupational Safety and Health (NIOSH) estimates that more than one million workers are exposed to MWFs. NIOSH conducted a comprehensive and systematic review of the epidemiologic studies that examined the association between MWF exposure and cancer. Substantial evidence was found for an increased risk of cancer at several sites (larynx, rectum, pancreas, skin, scrotum, and bladder) associated with at least some MWFs used prior to the mid-1970s. This paper provides the evidence pertaining to cancer at these sites. Cancer at those sites found to have more limited or less consistent evidence for an association with MWF (stomach, esophagus, lung, prostate, brain, colon, and hematopoietic system) will not be discussed in this paper but are discussed in the recent NIOSH Criteria for a Recommended Standard-Occupational Exposure to MWFs. Because the changes in MWF composition that have occurred over the last several decades may not be sufficient to eliminate the cancer risks associated with MWF exposure, reductions in airborne MWF exposures are recommended. Am. J. Ind. Med. 33:282–292, 1998. Published 1998 Wiley-Liss, Inc.

1 This article is a US Government work and, as such, is in the public domain in the United States of America.

     

Updated epidemiology of workers exposed to metalworking fluids provides sufficient evidence for carcinogenicity

The 1998 National Institute for Occupational Safety and Health (NIOSH) criteria document for metalworking fluids (MWF) is the most recent authoritative review of mortality studies of workers with these exposures. NIOSH concluded that substantial evidence exists for increased risk of cancer at several sites (larynx, rectum, pancreas, skin, scrotum, and bladder) among workers exposed to MWF before the mid-1970s, and that evidence is equivocal for cancer at several other sites, including stomach, esophagus, lung, prostate, brain, colon, and hematopoietic system. The UAW believes that systematic analysis of that body of data makes a much stronger case for stomach cancer related to MWF exposure. Since the Criteria document, the mortality experience of three of the cohorts reviewed has been either updated or reanalyzed. These updates strengthen the evidence for increased mortality from stomach and liver cancer, and non-malignant respiratory disease associated with exposure to water-based metalworking fluids. Additional toxicological data providing clear evidence for carcinogenicity of diethanolamine, a widely used ingredient, also increases the biological plausibility of these findings. Despite changes in composition of MWFs with time, and reduced exposure levels, these data contradict the notion that cancer risks have been eliminated.     

Pulmonary function in workers exposed to low levels of fuel-oil ash

Previously, we reported significant lung function changes after exposure to fuel-oil ash during a boiler overhaul in which median PM10 and vanadium concentrations were 2.9 mg/m3 and 11.9 micrograms/m3, respectively. In this study, we examined prospectively 18 boilermakers involved in the short-term, partial overhaul of a large, oil-fired boiler where occupational exposures to PM10 and metals were relatively low. Vanadium and PM10 exposure levels were measured before and during boiler work. For PM10, median exposure before and during boiler work was 0.5 and 0.6 mg/m3, respectively. For vanadium, median exposure before and during boiler work was 1.0 and 12.7 micrograms/m3, respectively, comparable with the results of our previous study. Spirometric (PFT) testing was done three times: first day on the job (PFT1), end of overhaul (PFT2), and 2 weeks post-overhaul (PFT3). Spirometry results were analyzed using repeated measures analysis of variance. No significant differences were found. Boilermakers working on a short-term overhaul of an oil-fired boiler exhibited no significant change in any lung function parameter comparing pre-, during, and 2 weeks post-exposure. The comparatively low levels of exposure to PM10 and vanadium observed during boiler work, the short duration of the overhaul, and the healthy worker effect are possible explanations for these results.     

Pulmonary function and symptoms of Nigerian workers exposed to cement dust

The pulmonary and nonpulmonary effects of cement dust exposure in 52 randomly selected, directly exposed cement workers and 24 maintenance workers were investigated. Compared with the nonindustrially exposed population, both subgroups had significantly (P less than 0.001) lower lung function. The lung function of the exposed subjects was probably influenced by the level of physical activity and the level of dust exposure. The more directly exposed cement packers had significantly (P less than 0.05) lower lung function than the less exposed cement loaders. There was no significant difference in the lung function of the directly exposed groups and the maintenance group, but the physically more active cement loaders showed higher lung function values than the maintenance workers. The lung function of the cement workers also decreased with the duration of employment. Cement dust produced significant (P less than 0.001) workshift depression in the lung function of the subjects. The symptoms presented by the subjects were cough and phlegm production, skin irritation, chest tightness, conjunctivitis, catarrh, stomachache, and boils. The prevalence of stomachache among the subjects becomes significant in the light of a finding by other workers of hepatic granuloma in cement workers. The measured dust level in the cement depot was 30.81 mg/m3.     

Pulmonary function and intradermal tests in workers exposed to soft-paper dust

A survey was carried out in the processing department of a paper mill, consisting of environmental and personal monitoring, a short questionnaire concerning chronic non-specific lung disease (CNSLD), spirometry, and intradermal tests. Spirometry was performed on Monday, Wednesday, and Friday. Exposures to paper dust regularly exceeded the Dutch Maximal Allowable Concentrations (MACs) for total and respirable dust. There were indications of a qualitatively different exposure to molds inside the mill in comparison with the outdoor air. A comparison between a group of workers exposed to paper dust and a control group showed significantly more persons with positive late and delayed intradermal test reactions in the exposed population. The analysis of the spirometric measurements after correction for differences between the groups in age, height, and smoking habits gave evidence of the existence of lower FEV1, MMEF, MEF50, and MEF25 among exposed workers with a positive immediate intradermal reaction on Friday. The same workers showed a decline in pulmonary function over the week compared with the controls. These changes suggest an obstructive airway reaction with an immunologic mechanism to dust exposure in a paper mill.