中国中老年人共病发展轨迹及其对新发失能的影响

目的 探索我国中老年人共病发展轨迹及其对新发失能的影响,以识别具有相似共病发展历程的同质群体,为我国中老年人群的失能风险干预提供依据。方法 基于中国健康与养老追踪调查2011-2018年4期数据,采用组基轨迹模型拟合共病发展轨迹,进而采用含时间依存协变量Cox回归模型分析其对新发失能的影响。结果 共纳入8 580名中老年人,依据中老年共病发展轨迹趋势,可分为无共病型（2 136人,24.90%）、新发-发展型（3 758人,43.80%）、适度-发展型（2 270人,26.45%）和严重-发展型（416人,4.85%）4种类型。适度-发展型和严重-发展型人群中女性、自评健康差、超重/肥胖、单身、居住在农村、家庭年人均支出水平高、发生新发失能的占比较高。调整人口学、行为学协变量后,与新发-发展型相比,严重-发展型（HR=3.132,95%CI：1.884~5.207）的失能风险最高,适度-发展型（HR=1.400,95%CI：1.026~1.909）次之,无共病型（HR=0.631,95%CI：0.424~0.938）最低。结论 我国中老年人的共病发展轨迹存在异质性,共病发展轨迹的失能风险随共病水平的升高而增加,提示共病发展轨迹升高是发生失能的危险因素。     

Examining the relationship between the demand-control model and incident myocardial infarction and congestive heart failure in a representative sample of the employed women and men in Ontario,Canada, over a 15-year period

ObjectivesTo examine the relationship between job strain and incident myocardial infarction and congestive heart failure in a representative population of men and women in Ontario, Canada, over a 15-year period.MethodsA total of 14,508 respondents having provided responses to either the 2000/2001, 2002, or 2003 cycles of the Canadian Community Health Survey (CCHS) were aged 35 and older at the time and working. After removing respondents with pre-existing heart disease and missing data, our sample totaled 13,291 respondents. Responses were linked to administrative health care and hospitalization data to capture incident cases of myocardial infarction and congestive heart failure up to March 31, 2017. Job control and psychological demands were assessed using 5 items and 2 items respectively. A series of time-to-event regression models were run, adjusting sequentially for socio-demographic variables and health, other psychosocial work exposures, and health behaviours and body mass index.ResultsOver the study period, there were 199,583 person-years of follow-up (median follow-up: 15 years, 233 days). Higher incidence rates were observed for men (6.69 per 100 persons) than for women (2.77 per 100 persons). No clear relationship was observed for demand-control exposures and incidence of myocardial infarction and congestive heart failure in either men or women. After adjustment for socio-demographic factors, pre-existing health conditions, and other psychosocial exposures, the hazard ratio for high strain exposure (compared with low strain exposure) was 0.92 (0.46–1.84) for women and 0.75 (0.44–1.27) for men.ConclusionIn this large prospective cohort in Canada, we observed no relationship between components of the demand-control model and incident myocardial infarction and congestive heart failure over a 15-year period.     

Occupational contact dermatitis in a gender perspective: North East Italian data 1996-2016

Background:Occupational contact dermatitis (OCD) ranks high among occupational diseases in Europe, but little is known as regards OCD and jobs in a gender perspective.Objectives:To evaluate sex prevalence of OCD according to occupational sectors and agents involved. 27381 patients (1996–2016) with suspected irritant/allergic contact dermatitis (ICD-ACD) were evaluated in North-Eastern Italy. Each patient underwent: a standardized questionnaire, a dermatologist/occupational physician evaluation and a patch test.Results:Females were younger at diagnosis (35.2 ± 11.6 years vs 37.7 ± 12.6 in males, p< 0.001) and had a lower ICD prevalence (OR 0.58, C.I. 95% 0.51 - 0.66, p < 0.001). Job categories most involved differed between sexes, with highest rank for healthcare professionals in females and machinery mechanics and filters for males. In females ACD percentage was higher in all job categories.Conclusions:OCD characteristics differ between sexes, according to intrinsic and extrinsic factors. Use of personal care products, housekeeping products and outdoor work activities may account for different sensitization profiles.     

Sampling‐based estimation for massive survival data with additive hazards model

For massive survival data, we propose a subsampling algorithm to efficiently approximate the estimates of regression parameters in the additive hazards model. We establish consistency and asymptotic normality of the subsample‐based estimator given the full data. The optimal subsampling probabilities are obtained via minimizing asymptotic variance of the resulting estimator. The subsample‐based procedure can largely reduce the computational cost compared with the full data method. In numerical simulations, our method has low bias and satisfactory coverage probabilities. We provide an illustrative example on the survival analysis of patients with lymphoma cancer from the Surveillance, Epidemiology, and End Results Program.     

流动人口职业病防治教育现状及影响因素分析

目的 了解流动人口职业病防治教育现状及影响因素。方法 运用SPSS 25.0软件对2017年全国流动人口卫生计生动态监测中的154586名流动人口的相关数据进行分析,主要分析方法有统计描述、χ2检验和二元logistic回归等。结果 154586名流动人口中,51578人接受过职业病防治教育,接受率为33.4%。二元logistic回归分析表明,男性（OR=1.165,95%CI:1.137~1.193）、30～44岁（OR=1.169,95%CI:1.088~1.256）、文化程度高中或中专（OR=1.278,95%CI:1.227~1.330）、在婚（OR=1.172,95%CI:1.134~1.211）、流动原因为经济性质（OR=1.283,95%CI:1.115~1.475）、流入西部地区（OR=1.749,95%CI:1.700~1.799）、有稳定工作（OR=1.071,95%CI:1.016~1.128）、机关或国企或股份联营企业（OR=1.765,95%CI:1.666~1.870）、自评状况为健康（OR=1.479,95%CI:1.363~1.606）的流动人口职业病防治教育接受率较高;未签订劳动合同（OR=0.684,95%CI:0.661~0.708）、未听过“国家基本公共卫生服务项目”（OR=0.231,95%CI:0.225~0.237）的流动人口职业病防治教育接受率较低。结论 流动人口职业病防治教育接受率较低,需加强流动人群职业病防治教育的宣传力度,提高职业病防治教育的覆盖面。     

ATTITUDES TOWARDS AND KNOWLEDGE OF OCCUPATIONAL SKIN DISEASE AMONGST SUPPORT PERSONNEL

Liaison with support personnel is important in the management of workers with occupational skin disease (OSD). This study shows that there are many areas of concern regarding the knowledge and understanding of OSD in these groups. There needs to be a comprehensive education programme concerning OSD within the working community and support personnel. Dermatologists need to simplify their "language' in the reporting of OSD. Insurers need to take a more sympathetic attitude towards the partially fit worker. Rehabilitation personnel must become more familiar with OSD.     

High exposures to organic solvents among graffiti removers

Summary The exposure to organic solvents among 12 graffiti removers was studied. Health effects were also assessed by structured interview and a symptom questionnaire. Blood and urine samples were collected at the end of the day of air sampling. The concentrations of dichloromethane, glycol ethers, trimethylbenzenes and N-methyl-2-pyrrolidinone in the breathing zone of each worker were measured during one working day. The 8-h time-weighted average exposure to dichloromethane ranged from 18 to 1200 mg/m³. The Swedish Permissible Exposure Limit value for dichloromethane is 120 mg/m3. The air concentrations of glycol ethers, trimethylbenzens and N-methyl-2-pyrrolidinone were low or not detectable. No exposure-related deviations in the serum concentrations of creatinine, aspartate transaminase, alanine transaminase, -glutamyl transpeptidase or hyaluronan or the urine concentrations of ₁-microglobulin, R2-microglobulin or N-acetyl--glucos-aminidase were found. Irritative symptoms of the eyes and upper respiratory tract were more prevalent than in the general population. This study demonstrates that old knowledge about work harzards is not automatically transferred to new professions. Another aspect is that the public is also exposed as the job is performed during daytime in underground stations. At least for short periods, bystanders may be exposed to high concentrations of organic solvent vapours. People with predisposing conditions, e.g. asthmatics, may risk adverse reactions.     

Biological monitoring of occupational exposure to toluene diisocyanate

Summary The study validated the use of urinary toluene diamine (TDA) in postshift samples as an indicator of preceding 8-h exposure to toluene diisocyanate (TDI). Nine workers exposed in TDI-based polyurethane foam production were studied. Their exposure levels varied in 8-h time-averaged samples from 9.5 to 94 g/m³. The urinary TDA concentrations varied from 6.5 to 31.7g/g creatinine and they were linearly related to the atmospheric TDI levels. Approximately 20% of TDI is metabolized to diamines but their specificity is remarkable to the extent that by analysis for the 2,4- and 2,6-diamino isomers an idea of the percutaneous absorption may be had.     

On the need of a sampling strategy in biological monitoring: The example of hexane exposure

Ambient and biological monitoring of hexane exposure were repeatedly carried out in 14 female shoe makers. Airborne hexane (Ci-H) was measured in 4-h samples collected by a diffusive method. Urinary spot samples were collected before, during (at noon), and at the end of a work shift. 2,5-Hexanedione (2,5HD) in urine collected at noon was poorly related to morning Ci-H. End-of-shift 2,5HD were also poorly related to afternoon air samples. The correlation was still relatively low when end-of-shift 2,5HD was related to 8-h TWA Ci-H (r= 0.44; P<0.01 on=" a=" linear=" scale,=" and=">r-0.58, P< 0.01=" on=" a=" log-log=" scale).=" end-of-shift=" 2,5hd=" levels=" estimated=" on=" the=" basis=" of=" pre-shift=" values=" using=" a=" mathematical=" model=" were=" much=" higher=" (2.3=" times=" on=" average)=" than=" those=" experimentally=" measured=" during=" the=" study=" period.=" owing=" to=" its=" relatively=" long=" half-time,=" 2,5hd=" seems=" to=" be=" influenced=" not=" only=" by=" current=" exposure,=" but=" also=" by=" hexane=" absorbed=" during=" the=" day(s)=" preceding=" sampling.=" the=" lack=" of=" a=" sampling=" strategy=" may=" account=" not=" only=" for=" inconsistencies=" between=" environmental=" and=" biological=" data,=" but=" also=" for=" a=" possible=" misuse=" of=" biological=" monitoring=" when=" utilized=" for=" risk=" assessment.=" despite=" sometimes=" poor=" correlations=" with=" ci-h,=" 2,5hd=" may=" still=" be=" preferred=" to=" other=" indicators=" as=" a=" marker=" of=" effective=" internal=" dose.=" a=" sampling=" strategy=" should=" ensure=" that=" measured=" values=" are=" representative=" of=" the=" individual=" risk=" for=" adverse=">     

Cancer risk assessment for health care workers occupationally exposed to cyclophosphamide

In the present study a cancer risk assessment of occupational exposure to cyclophosphamide (CP), a genotoxic carcinogenic antineoplastic agent, was carried out following two approaches based on (1) data from an animal study and (2) data on primary and secondary tumors in CP-treated patients. Data on the urinary excretion of CP in health care workers were used to estimate the uptake of CP, which ranged from 3.6 to 18 g/day. Based on data from an animal study, cancer risks were calculated for a health care worker with a body weight of 70 kg and a working period of 40 years, 200 days a year (linear extrapolation). The lifetime risks (70 years) of urinary bladder cancer in men and leukemias in men and women were found to be nearly the same and ranged from 95 to 600 per million. Based on the patient studies, cancer risks were calculated by multiplication of the 10-year cumulative incidence per gram of CP in patients by the estimated mean total uptake in health care workers over 10 years, 200 days a year. The risk of leukemias in women over 10 years ranged from 17 to 100 per million using the secondary tumor data (linear extrapolation). Comparable results were obtained for the risk of urinary bladder tumors and leukemias in men and women when primary tumor data were used. Thus, on an annual basis, cancer risks obtained from both the animal and the patient study were nearly the same and ranged from about 1.4 to 10 per million. In The Netherlands it is proposed that, for workers, a cancer risk per compound of one extra cancer case per million a year should be striven for (target risk) and that no risk higher than 100 per million a year (prohibitory risk) should be tolerated. From the animal and the patient study it appears that the target risk is exceeded but that the risk is still below the prohibitory risk.