A systematic review of occupational exposure to respirable coal mine dust(RCMD)in the U.S.mining industry

Cumulative inhalation of respirable coal mine dust(RCMD)can lead to severe lung diseases,including coal worker's pneu-moconiosis(CWP),silicosis,mixed dust pneumoconiosis,dust-related diffuse fibrosis(DDF),and progressive massive fibrosis(PMF).Statistics from the number of reported cases showed a significant decrease in the progression of respiratory diseases in the 1990s.However,an unexpected increase in the number of CWP cases was reported in the late 1990s.To date,there has been no comprehensive systematic review to assess all contributing factors to the resurgence of CWP cases.This study aims to investigate the effects of various mining parameters on the prevalence of CWP in coal mines.A systematic review using the preferred reporting items for systematic reviews and meta-analysis(PRISMA)method was conducted to investigate the health effects of RCMD exposure and identify the factors that may contribute to the recent resurgence of CWP cases.The systematic review yielded a total of 401 papers,which were added to the database.The total number of 148 and 208 papers were excluded from the database in the process of screening and eligibility,respectively.Then,18 papers were considered for data selection and full-text assessment.The review revealed that factors including geographic location,mine size,mining operation type,coal-seam thickness,coal rank,changes in mining practices,technology advancement,and engi-neering dust control practices are contributing to the recent resurgence of CWP among coal workers.However,the evidence for root causes is limited owing to the methodological constraints of the studies;therefore,further detailed studies are needed.

Transition from minimal change disease to focal segmental glomerulosclerosis related to occupational exposure:A case report

BACKGROUND Although minimal change disease(MCD)and focal segmental glomerulosclerosis(FSGS)have been described as two separate forms of nephrotic syndrome(NS),they are not completely independent.We report a case of a patient transitioning from MCD to FSGS,review the literature,and explore the relationship between the two diseases.CASE SUMMARY A 42-year-old male welder,presenting with lower extremity edema and elevated serum creatinine,was diagnosed with NS and end-stage kidney disease(ESKD)based on laboratory test results.The patient had undergone a kidney biopsy for NS 20 years previously,which indicated MCD,and a second recent kidney biopsy suggested FSGS.The patient was an electric welder with excessive levels of cadmium and lead in his blood.Consequently,we suspect that his aggravated pathology and occurrence of ESKD were related to metal nephrotoxicity.The patient eventually received kidney replacement therapy and quit his job which involved long-term exposure to metals.During the 1-year follow-up period,the patient was negative for metal elements in the blood and urine and recovered partial kidney function.CONCLUSION MCD and FSGS may be different stages of the same disease.The transition from MCD to FSGS in this case indicates disease progression,which may be related to excessive metal contaminants caused by the patient’s occupation.

Prevalence of Occupational Injury and Knowledge of Post-Exposure Prophylaxis Accessibility among Healthcare Workers in Mogadishu, Somalia

Introduction: Healthcare workers in Mogadishu, Somalia face significant occupational injury risks, particularly needle stick injuries, with 61.1% reporting incidents. This poses a serious threat to their health, leading to infections such as hepatitis B, hepatitis C, and HIV. Despite the high prevalence of injuries, awareness of Post-Exposure Prophylaxis (PEP) accessibility is relatively high, with 84.0% of respondents aware of it. However, there are gaps in knowledge and implementation, as evidenced by variations in availability of PEP. Improving workplace safety measures, providing comprehensive training on injury prevention and PEP protocols, and ensuring consistent availability of PEP in healthcare facilities are crucial steps to safeguard the well-being of healthcare workers in Mogadishu, Somalia. Methods: A cross-sectional study was conducted among hospital workers in Mogadishu, Somalia, focusing on professionals from various healthcare facilities. The study targeted nurses, doctors, laboratory personnel, and pharmacists. Purposive sampling was employed, resulting in a sample size of 383 calculated using Fisher’s sample size formula. Data were collected using coded questionnaires entered into Microsoft Excel 2019 and analyzed with SPSS software to generate frequencies and proportions, presented through frequency tables and pie figures. Results: The study in Mogadishu, Somalia, examined the prevalence of occupational injuries and knowledge of Post-Exposure Prophylaxis (PEP) accessibility among healthcare workers. Findings indicate a high prevalence of injuries, with 61.1% reporting incidents, predominantly needle stick injuries (60.6%). Despite the majority seeking prompt medical attention (72.0%), work-related illnesses affected 53.2% of respondents, notably work-related stress (59.5%). While most received training on injury and illness prevention (68.9%), gaps exist in PEP awareness, with 16.0% unaware of it. Nonetheless, 84.0% were aware, predominantly through health facilities (52.0%). Availability of PEP was reported by 71.3% in healthcare facilities, with variations in shift availability. The majority reported guidelines for PEP use (55.7%). Efforts are needed to bolster PEP awareness and ensure consistent availability in healthcare facilities to safeguard worker health. Conclusion: High prevalence of occupational injuries among healthcare workers, with needle stick injuries being the most common (60.6%). Despite this, 84.0% of respondents were aware of Post-Exposure Prophylaxis (PEP), primarily learning about it from health facilities (52.0%). While 71.3% reported the availability of PEP in their facility, 28.7% noted its unavailability. These results emphasize the need for improved education and accessibility of PEP to mitigate occupational injury risks.

Modelling Pathways for Outbreaks in Field Occupational Epidemiology

Background: The investigation of an occupational outbreak, once the index case has been identified, triggers a stress situation to epidemiologists. Modelling occupational outbreaks will be useful to guide the field investigation. Objective: To identify standard pathways for occupational epidemic outbreaks. Methods: In-depth critical appraisal of 57 occupational outbreaks. Standard pathways of occupational outbreaks were identified by analysing the similarity between out-breaks. The model’s accuracy and homogeneity were established through Fisher’s exact test and the Kappa Index. Results: The analysis allowed synthesizing the occupational outbreaks variability in 4 pathways. 92.98% of the analysed outbreaks could be allocated to one of those 4 types. The theoretical patterns showed a good adjustment with the analysed out-breaks: Type I (Kappa = 0.94 - 0.60), Type II (Kappa = 1.00), Type III (Kappa = 1.00 - 0.68) and Type IV (Kappa = 0.94 - 0.87). The probability of a given outbreak fitting with its three components in any of the theoretical pathways was 0.83. Conclusions: The incorporation of those pathways to the field occupational epidemiology will allow: 1) to provide early guidance to epidemiological, clinical and environmental studies focused on specific hypothesis of causality;2) to anticipate preventive measures;3) to contribute to an earlier and more efficient outbreak resolution.

煤矿工人职业健康研究进展的知识图谱分析

为研究煤矿工人职业健康的发展趋势,促进煤炭企业实施职业健康防护工作,基于知识图谱分析方法,采用CiteSpace软件分析中国知网(CNKI)和Web of Science(WoS)核心数据库中收录的近20年煤矿工人职业健康文献的关键词聚类及突现。研究结果表明:煤矿工人职业健康研究可分为职业健康危害因素、职业病及职业相关疾病三维度。职业相关疾病主要体现在行为和身心疾病、心脑血管疾病与代谢性疾病及慢性非特异性呼吸系统疾病3个层面;与职业病相比,职业相关疾病多呈现为“多因一果”特征,确诊难度更大;基于高频词突现特征,尘肺、听力损失、心理压力、高血压等是煤矿工人健康的主要威胁,此类健康问题与职业暴露有关,风险评价与管控是应对危害的重要措施;新兴研究热点为职业相关疾病的成因与防范,及职业健康与脑科学、智能化等领域的交叉研究。

牙体牙髓病科工作有关疾病的研究进展

牙体牙髓病科医护人员长期处在特殊的工作环境与条件下,不可避免地面临各种工作有关疾病的威胁,严重影响着医护人员的身心健康与工作效率。因此,开展针对牙体牙髓病科工作有关疾病的研究,并在实践中加以预防与干预,显得非常必要。本文将借助多方面的研究和数据,系统分析工作场景的危害因素与机制,帮助早期识别不同类型的工作有关疾病,然后提出针对性的预防措施,借此改善医护人员的工作环境和健康状态,提高诊疗质量和患者的满意度。

县级医院护理人员血源性传染病职业暴露现状调查

目的 了解涡阳县县级公立医院护理人员发生血源性传染病职业暴露的现状及其影响因素,为制定该人群的干预措施提供依据。方法 对涡阳县县级公立医院的在职护理人员开展职业暴露问卷调查。结果 共调查655名在职护理人员。从执业开始至今发生过职业暴露的为20.61%,近1年发生过职业暴露的为6.11%。多因素logistic回归分析显示,本科及以上文化程度、工龄越长、最近1年发生过割伤、黏膜暴露的护理人员更容易发生血源性传染病职业暴露;手术室、传染科以及大内科的护理人员相比其他科室更容易发生血源性传染病职业暴露。结论 涡阳县县级公立医院护理人员发生血源性传染病职业暴露的风险较高。医院应继续完善院感防控工作,加强护理操作流程的标准化建设,规范开展护理工作,进一步降低护理人员血源性传染病的职业暴露风险。

某三级甲等中医医院2014—2023年血源性职业暴露监测与防护策略研究

目的分析某三级甲等中医医院医务人员血源性职业暴露的流行病学特征、原因与处置情况,为降低暴露风险提供参考。方法采用回顾性研究方法,收集2014年1月—2023年12月某中医医院血源性职业暴露上报资料,并进行描述性分析。结果2014—2023年医务人员血源性职业暴露报告发生率为3.08%(527/17098)。其中破损皮肤或黏膜暴露55例次,发生率为0.32%;锐器伤472例次,发生率为2.76%,两者比较差异有统计学意义(χ^(2)=335.125,P<0.001)。血源性职业暴露中主要为锐器伤(89.56%)、女性(83.49%)、工龄<5年(42.69%)、中级职称(67.93%)的医务人员。破损皮肤或黏膜暴露以医生为主(58.18%),锐器伤以护士为主(73.73%)。内科锐器伤暴露最高(42.80%),手术室破损皮肤或黏膜暴露最高(47.27%)。锐器伤发生环节主要为拔针(21.82%)、处置使用过的锐器物与随意放置锐器(20.34%)和注射、穿刺、针灸、封管或采血(19.49%)。71.73%的暴露来源明确,检出经血传播病原体前三位分别为乙型肝炎病毒(70.86%)、丙型肝炎病毒(11.92%)和梅毒螺旋体(9.27%),暴露后正确处置率为88.05%。结论2014—2023年该中医医院血源性职业暴露以锐器伤为主,护士在拔针、处置使用过的锐器物等过程中发生较多,破损皮肤或黏膜暴露主要为医生在手术过程中患者血液喷溅至眼睛。

感染性疾病相关医务人员职业风险现状及防控对策

目的调查感染性疾病相关医务人员职业风险,分析其成因并提出相应的防控对策。方法利用问卷调查法,根据感染性疾病相关医务人员职业风险来源,分别从职业暴露、医患纠纷、心理压力和社会转嫁等方面调研其风险存在样态。结果23.25%的感染性疾病相关医务人员经历过职业暴露,其中44.57%认为职业暴露的发生是由于操作时注意力不集中。针刺伤等物理性危险因素发生概率最大,感染风险最高的疾病是乙型肝炎与丙型肝炎。78.52%的感染性疾病相关医务人员认为医患纠纷的主要成因在于患者方面。感染性疾病相关医务人员心理压力的主要来源分别是工作强度(77.98%)、医患矛盾(57.54%)、薪资问题(48.23%)。结论鉴于感染性疾病相关医务人员存在的职业风险,本文从医院、政府、社会、个人四方面提出对策,以加强职业风险防控。

传染病医院快速组建医疗队伍的教育培训模式实践与探讨

目的 探讨为收治突发传染病而快速组建的医疗队伍的教育培训模式及实施效果。方法 依据突发传染病患者的收治情况,根据工作需要定期组织医务人员开展传染病救治工作,本研究在东莞市第九人民医院开展,研究对象主要为2020年1月至2022年12月参与突发传染病救治的医务人员。以2022年2月为时间界限,时间界限之前参与救治的医务人员为对照组,之后的医务人员为实验组,两组各430名。对照组应用常规教育培训方法,实验组应用优化教育培训方法。比较两组在培训前后的考核情况,比较两组进入病区后呼吸道职业暴露、防护用品使用不规范、脱卸防护用品污染自身以及未按照规定路线出入病区等事件的发生率情况。结果 两组队员在培训前的感染防护操作技能、理论知识考核分数,差异无统计学意义(P> 0.05),培训后的理论、操作分数均比培训前提高且实验组高于对照组,差异有统计学意义(P <0.05);实验组医务人员进入病区后呼吸道职业暴露、防护用品使用不规范、脱卸防护用品污染自身以及未按照规定路线出入病区等事件的发生率均低于对照组,差异有统计学意义(P <0.05)。结论 针对传染病医院快速组建的医疗队伍,应用优化教育培训模式,有助于提高医疗队员的专业素养,提高感染防护理论及操作能力,降低医务人员职业暴露及不良事件发生率。

职业性三氯乙烯中毒分析

目的:了解近年来深圳市宝安区职业性三氯乙烯(trichloroethylene ,TCE)中毒发病和死亡情况,为三氯乙烯中毒预防和机理研究提供依据。方法:以1 993～2 0 0 3年诊断的三氯乙烯中毒病人为研究对象,分析患者年龄、性别、工龄、累积时间加权浓度、行业等构成特征。结果:TCE中毒病人共83例,其中1 4人死亡,病死率1 6.9%。TCE职业中毒病例临床表现有如下共同特征:1、发热;2、皮肤损害,以弥漫性斑丘疹最为常见,严重者发展为表皮坏死松解症;3、化学性肝脏损伤,主要表现为血清转氨酶等指标显著增高;4、潜伏期为3 0d左右;5、无明显的男女性别差异,无明显的年龄构成差异;6、有明确的接触TCE职业史,但无明显的剂量-反应关系;7、尿三氯乙酸与中毒无明确对应关系,中毒患者三氯乙酸浓度不一定超标,超标者也不一定有临床表现。结论:TCE引起的职业损伤是本区的主要危害因素之一,其所引起的病症与传统的毒理学描述不同。

职业接触粉尘和烟雾对慢性阻塞性肺疾病及呼吸道症状的影响

目的探究职业接触粉尘和烟雾对COPD及呼吸道症状的影响。方法在中国7省市(北京、上海、广东、辽宁、天津、重庆和陕西)城乡40岁及以上人群的COPD横断面调查的基础上,分析职业接触粉尘和烟雾对COPD及呼吸道症状的影响。对入选人群进行问卷调查和肺功能检测。以支气管舒张试验后的FEV1/FVC<70%作为COPD的诊断标准,并排除其他不完全可逆气流受限疾病。患者自我报告经常有咳嗽、咳痰、气喘或气促症状之一,定义为有呼吸道症状。结果20.5%的被调查者曾经职业接触粉尘和烟雾超过1年。多因素分析显示,职业粉尘烟雾暴露是罹患COPD的危险因素,其OR值及95%CI为1.20(1.04,1.39),其中谷尘为COPD可能的危险因素,其OR值及95%CI为1.48(1.18,1.86);职业粉尘烟雾暴露、采矿、采石、水泥粉尘、油漆、化工和其他职业暴露为患呼吸道症状的危险因素,其OR值及95%CI分别为1.37(1.25,1.49)、2.31(1.67,3.20)、1.71(1.09,2.70)、1.92(1.47,2.52)、1.46(1.16,1.84)、1.58(1.37,1.83)和1.46(1.29,1.64);职业粉尘烟雾暴露与吸烟存在协同作用,可使患呼吸道症状的危险度增加(P=0.006);职业粉尘烟雾暴露对患COPD和呼吸道症状的人群归因危险度(PAR)分别为3.94%和7.05%。结论职业粉尘烟雾暴露与患COPD和呼吸道症状有关;职业粉尘烟雾暴露与吸烟对患呼吸道症状存在协同作用。

护士工作中针刺伤现状及预防对策

目的 对临床护士针刺伤现状进行描述。 方法 采用问卷法对 44 1名临床护士进行现况调查 ,收集有关污染锐器处理情况、针刺伤发生率、与针刺伤有关的操作、针刺伤意外后的处理及心理反应。 结果 82 %的护士在过去的 1年发生过针刺伤 ,与针刺伤有关的操作有套针帽、分离针头、处理针头等。护士在发生针刺伤后采取的主要措施是消毒伤口和挤压伤口 ,5 2 .4%的护士在发生针刺伤后感到害怕。 结论 临床护士针刺伤发生率高 ,污染锐器处理不安全。医院管理部门应加强医护人员职业防护培训 ,规范医疗废物的处理等方面减低医护人员针刺伤 。

某院医务人员血源性职业暴露的流行病学研究

目的掌握某院医务人员血源性职业暴露的流行病学特征。方法采用随机偶遇的方法对该院374名临床医务人员进行回顾性问卷调查。结果医务人员职业暴露后处理内容和处理流程正确率分别为54.81%(205/374)、89.84%(336/374)。共发生血源性职业暴露174例、533例次,暴露率为46.52%(174/374)。不同科室、岗位医务人员职业暴露率比较,差异有统计学意义(P<0.05);外科、儿科和内科的医务人员暴露率较高,分别为64.46%(78/121)、60.00%(18/30)和40.00%(50/125);护士和医生暴露率较高,分别为51.52%(102/198)、47.27%(52/110)。医务人员血源性暴露时间主要集中在上午和晚上,穿刺、采血或处理物品为主要的暴露环节,暴露地点主要是病房和手术或换药室。结论该院医务人员血源性职业暴露率较高,应加强医院高危科室、人员和操作的血源性职业暴露防控措施的落实。

某妇幼保健机构工作人员职业暴露监测

目的了解某妇幼保健院工作人员职业暴露情况,探讨职业暴露相关危险因素及预防对策。方法对该院2012年1—12月间55名工作人员发生职业暴露的监测数据进行统计分析。结果共发生工作职业暴露55例、57例次。其中暴露源不明确31例次(54.39%),暴露源情况明确26例次(45.61%)。57例次职业暴露人员中,保洁员和护士占82.46%(47例次),其职业暴露发生率分别为9.76%和5.32%。职业暴露发生率居前3位的科室是门急诊、产科和保洁部,分别为29.51%、9.80%和9.76%;暴露人员的工龄≤3年者占87.72%(50例次)。暴露种类以锐器伤为主,占94.74%(54例次),暴露物以头皮钢针为主(42.11%),其次为注射器针头(19.30%)。职业暴露主要环节为拔针(29.83%),其次为医疗废物处置(28.07%)。结论保洁员、护士和低年资工作人员是职业暴露高危群体,应采取相关的防范措施,加强对其职业防护教育培训;加强对重点部门、环节的管理,降低医院工作人员职业暴露危害。

医务人员经血源传播疾病职业暴露危险因素与预防

目的了解医务人员在经血源传播性疾病职业暴露的危险因素,并探讨预防措施,为防止医务人员职业暴露,保障医务人员健康提供参巧。方法对163例医务人员被患者的血液、体液等污染的锐器伤或被患者的血液、体液等直接喷溅污染了粘膜或破损皮肤的原因、方式以及发生地点、工作类别、职称等因素进行调查分析和追踪。结果共发生职业暴露163例次,暴露率10.2%。暴露原因锐器伤146例次,占总数的89.6%。暴露率以手术室最高(占71.7%),其次为急诊科(47.5%)。暴露人群以护士、初级以下职称暴露率最高,分别为26.4%、14.3%。不同科室、职业、职称发生职业暴露的差异有统计学意义(p均<0.005)。发生职业暴露后,均进行紧急和进一步处理、追踪,无发现职业暴露感染个案。结论医护人员经血液传播疾病的职业感染危险性增加,锐器伤是造成医务人员职业暴露而引发血源传播性疾病感染的最高危因素,低年资护士是血源传播性疾病职业暴露发生最高危群体。医务人员尤其护士的防护意识仍较薄弱,不按规程操作是导致职业暴露的最危险因素。加强安全知识和技能的训练,规范操作,纠正不良工作习惯和行为,减少针刺伤乃是预防医务人员职业暴露的最有效对策。

临床免疫实验室医院感染的危险因素与控制对策

目的探讨临床免疫实验室医院感染危险因素和防治对策。方法对2004年7月-2005年7月,临床免疫实验室检测的乙型肝炎病毒、甲型肝炎、丙型肝炎、丁型肝炎、戊型肝炎、艾滋病、梅毒、结核抗体共91 877例标本的阳性检出率进行统计分析。结果检出乙型肝炎患者和HBV携带者8 376例、甲型肝炎7例、丙型肝炎26例、丁型肝炎24例、戊型肝炎107例、艾滋病病毒携带者3例、梅毒522例、结核52例,检测阳性率分别为16.68%、0.43%、0.20%、2.22%、6.49%、0.03%、4.75%、4.61%。结论了解临床免疫实验室存在的传染源和危险因素,对加强医院实验室感染的控制和实验室工作人员职业暴露的防护,具有重要意义。

输血传播疾病标志物快速检测与职业暴露

目的增强医护人员职业防护意识,探讨可能的防护方法,减少职业暴露的发生。方法对7089份急诊患者血清进行HBsAg、抗HCV、人类免疫缺陷病毒抗体(抗HIV)、梅毒螺旋体特异性抗体(抗TP)快速和酶联免疫吸附试验(ELISA)检测。结果7089份急诊手术患者血清中,HBsAg、抗HCV、抗HIV和抗TP快速检现特异性分别为99.67%,99.55%,99.79%和99.76%;灵敏度分别为68.97%,62.74%,88.89%和70.37%;检测效率分别为97.59%,98.74%,99.76%和99.65%。结论临床医护人员,尤其是麻醉手术科和外科医护人员,容易遭受输血传播疾病的暴露,具有很高的传播疾病的危险性。因此,应采取针对性的防护安全教育,预防事故发生。

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。

一所三级传染病医院连续5年医务人员血源性职业暴露特点

目的探讨某传染病医院连续5年医务人员职业暴露及与工作强度的相关性,为做好职业防护工作提供依据。方法回顾性分析2010年1月—2014年12月某院上报的职业暴露案例,统计分析其职业类型、暴露途径、暴露源等资料。结果共上报228例职业暴露事件,护士(75.44%)和医生(19.30%)为职业暴露的主要人群;输液过程为职业暴露的主要途径,占52.19%;乙型肝炎病毒(HBV)为主要暴露源,占71.05%,其次为人类免疫缺陷病毒(HIV,占10.09%)。医生职业暴露率与医患比、护士职业暴露率与护患比Pearson相关系数分别为-0.849和-0.823,均P<0.05。结论护士为职业暴露高危人群,输液过程中最易发生职业暴露,医生和护士的职业暴露与其工作强度相关。