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To revise GBZ 188 Technical Specification for Occupational Health Surveillance based on national laws, regulations, standards, specifications and legal documents of occupational disease, and combination with the actual situation in China. The main modifications are as follows: the occupational health surveillance for workers exposed to toluene (xylene may implement by reference), bromopropane, methyl iodide, ethylene oxide, chloroacetic acid, indium and its compounds, coal tar, coal tarasphalt, asphalt, β-naphthylamine, dust of metal and its compounds(tin, iron, antimony, barium and its compounds), hard metal dust, erionite dust, low temperature, laser, tick-borne encephalitis virus, Borrelia burgdorferi, and human immunodeficiency virus, for scraper or grind operators, and underground workers using squatting or kneeling position, crawling position, side-lying position, or shoulder position for a long period of time are included. The emergency health screening for workers exposed to arsenic, fluorine and its inorganic compounds, and acrylamide are included. The occupational medical examination (OME) for workers exposed to amino and nitro compounds of benzene, phosgene, monomethylamine, organic fluorine and dimethyl sulfate has been adjusted and made mandatory, with corresponding assessments required upon leaving the job. The special occupational health surveillance for workers exposed to mycobacterium tuberculosis and hepatitis virus is removed. The OME conclusion of reexamination is removed, and standardize recheck/additional inspection requirements. The optional items in OME performed before, during and after leaving post are removed, but the optional items in emergency medical examination are retained. Additional OME items are added. The Guideline for OME Summary Reports is added as informative appendix, and so on. The revised GBZ 188 Technical Specification for Occupational Health Surveillance is more scientific and practical.
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Background As one of the common tools for job burnout assessment, Maslach Burnout Inventory-General Survey (MBI-GS), its reliability and validity across different populations in China have not been examined yet. Objective To evaluate the reliability and validity of General Burnout Scale (GBS) by multiple occupational groups through the translation and preliminary test of MBI-GS. Methods Based on the Special Project of Occupational Hazards in Key Populations led by the Institute of Occupational Health and Poison Control, China CDC, key occupational groups in five typical industries were selected by multi-stage stratified cluster sampling, including teachers, firefighters, manufacturing workers, medical staff, and traffic police. Confirmatory factor analysis (CFA) was used to evaluate the construct validity of GBS by single-factor, two-factor, and three-factor structure models. The model fitness was assessed by ratio of the chi-square statistic to the respective degrees of freedom (χ2/ν), root mean square error of approximation (RMSEA), goodness-of-fit index (GFI), comparative fit index (CFI), and parsimony-adjusted non-normed fit index (PNFI). Spearman correlation analysis was used to calculate the criterion validity of GBS with occupational stress, depressive symptoms, and sleep disorders. Cronbach's α coefficient and composite reliability (CR) coefficient were used to evaluate the internal consistency reliability of GBS. Results A total of 3485 subjects were surveyed in this study, 3375 valid questionnaires were recovered with a valid response rate of 96.84%. The results of CFA showed that in the adjusted three-factor structure model of GBS (exhaustion, cynicism, and professional efficacy), the χ2/ν < 4, the RMSEA ranged from 0.032 to 0.069, the GFI > 0.90, the CFI > 0.90, and the PNFI > 0.70, which illustrated a good fitness than that of the single- or the two-factor structure models in different occupational groups. The Spearman correlation analysis results showed that occupational stress, depressive symptoms, and sleep disorders were positively correlated with exhaustion and cynicism dimensions, and negatively correlated with professional efficacy dimension of the GBS, with the \begin{document}$ \left| r \right| $\end{document} ranging from 0.139 to 0.662 (P<0.05) in overall subjects. For traffic police and firefighters, professional efficacy was not correlated with depressive symptoms or sleep disorders (P>0.05). The Cronbach's α coefficients ranged from 0.819 to 0.899, and the CR values ranged from 0.941 to 0.978 in different occupational groups. Conclusion The GBS shows high reliability and validity, as well as good application effects in different occupational groups.
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Objective@#To investigate the high occupational stress and its influencing factors in traffic police in Shanghai.@*Methods@#728 traffic police were selected as the study subjects, and the《Occupational Health Questionnaire》was used to investigate and evaluate their job demand-control (JDC) and effort-reward imbalance model (ERI) occupational stress situation respectively. The related influencing factors were analyzed.@*Results@#The prevalence rates of high occupational stress in JDC and ERI models were 74.6% (543/728) and 51.5% (375/728) . The influencing factors of JDC were education, marriage, average weekly hours (χ2=16.82, 10.04, 18.71, P<0.05) , and The influencing factors of ERI were gender, age, marriage, real monthly income level, education, work experience, and average weekly hours (χ2=7.02, 26.18, 6.73, 50.42, 4.75, 26.61, 112.98, 6.19, P<0.05) . The JDC multivariate logistic analysis indicated that the risk of occupational stress of married police was 2.81 times as high as that of Unmarried ones. The risk of occupational stress of traffic police with more education was 1.92 times as high as that of low eduacation, average weekly working 41-50 hours and≥51 hours was 2.53, 3.12 times as high as that of ones with average working 40 hours, respectivly. Meanwhile, the ERI multivariate logistic analysis indicated that high income level is the protective factor of occupational stress. The traffic police with 15-<20 working years were more likely to occur higher occupational stress. The traffic police with the more average weekly hours had greater possibility of higher occupational stress.@*Conclusion@#The main influencing factors of JDC and ERI are marriage, real monthly income level, education, work experience, and average weekly hours.
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Objective@#To explore the characteristics of auditory steady state evoked responses (ASSR) and auditory brainstem response (ABR) in noise-induced hearing loss population and the relationship between the response threshold of corresponding frequency and pure tone audiometry (PTA) .@*Methods@#Noise-induced hearing loss patients who completed subjective and objective audiometry in our hospital from October 2014 to October 2018 were collected. The results of PTA, ABR, ASSR and the correlation between subjective and objective audiometry were discussed.@*Results@#A total of 381 ears of 193 patients were enrolled. The difference of 0.5, 1.0, 2.0 and 4.0 kHz between ASSR threshold and PTA was 5.9, 6.9, 11.8 and 1.8 dB, respectively. The correlation coefficients were 0.638, 0.680, 0.657 and 0.608. The difference of 1.0, 2.0, 3.0 and 4.0 kHz between ABR threshold and PTA was 44.2, 35.0, 19.0 and 2.0 dB. With the increase of frequency, the threshold difference between ABRt V wave and PTA decreased gradually.@*Conclusion@#ASSR and ABR response thresholds are valuable in subjective assessment on noise-induced hearing loss. The thresholds of ASSR and ABR at 4 kHz are close to those of PTA.
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Objective@#To study the airway inflammation feature difference in the patients with occupational pulmonary thesaurosis induced by iron.@*Methods@#Induced sputum samples were obtained from 20 healthy men, 20 patients with stable asthma, 25 patients with occupational pulmonary thesaurosis induced by iron. Differential cell counts in induced sputum were examined. The levels of supernatant IL-8 were measured by ELISA.@*Results@#The pulmonary function result was normal in the patients with pulmonary thesaurosis., their FVC (4.1±1.2) L was similar to FVC (4.3±0.9) L in mal group; but their FEV1.0 (2.9±0.9) L、FEV1/FVC (71.9%±5.4%) were lower than normal group’s FEV1.0 (3.2±0.7 L) 、FEV1.0/FVC (79.2%±9.9%) , and were hirher than asthma group’s FEV1 (2.5±0.8) L and FEV1.0/FVC (68.7%±6.1%) . In induced sputum, macrophages percentage in patients with pulmonary thesaurosis (54.3%±9.7%) was higher than asthma group and normal group (48.4±6.4, 51.9±7.3, P<0.05) , neutrophils percentage in patients with pulmonary thesaurosis group (43.9%±7.6%) was higher than asthma group and normal group (41.3%±7.1%, 39.8%±6.9%, P<0.05) , eosinophils percentage in patients with pulmonary thesaurosis group (0.3%±0.1%) was lower than asthma group (2.8±0.3, P<0.05) , lymphocytes percentage in patients with pulmonary thesaurosis group (2.0%±0.4%) was lower than asthma group (4.7±0.6, P<0.05) ; the sputum levels of IL-8 in patients with pulmonary thesaurosis group (914.7±24.3) pg/ml was higher than asthma group and normal group (747.9%±16.8 pg/ml, (405.4±13.7) pg/ml, P<0.05) .@*Conclusion@#Macrophages and IL-8 may play an important role in the pathogenesis of airway inflammation after long-term inhalation of iron and its compounds, the airway function in patients of occupational pulmonary thesaurosis was found damaged.
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Objective@#The method was established for the detection of whole blood indium and serum indium. By comparing the results of two samples, it is possible to explore the significance of whole blood indium and serum indium in the population exposed to indium compounds.@*Methods@#According to GBZ/T 295-2017 and GBZ 294-2017, the whole blood and serum samples were diluted 20 times by 0.5% nitric acid solution (including 0.05% Triton X-100) . Under the standard mode of inductively coupled plasma mass spectrometry (ICP-MS) , whole blood indium and serum indium of indirect exposure group, low exposure group and high exposure group in an indium mine were detected with 20 μg/L rhodium standard solution as internal standard.@*Results@#This method has a working range of 0.00~5.00 μg/L and a correlation coefficien t>0.999. The detection limit and quantitative lower limit of whole blood indium were 0.076 μg/L and 0.26 μg/L respectively. Those of serum indium were 0.06 μg/L and 0.20 μg/L accordingly. The recovery rates of serum and whole blood samples were 88.5%~95.6% and 93.0%~101%. Intra batch precisions were 1.3%~4.4% and 1.9%~3.5% and inter batch precision were 2.4%~6.1% and 2.1%~4.6% in two samples. There were no significant differences between whole blood indium and serum indium in indirect exposure group. The serum indium level was lower than the detection limit in 3 cases, while their whole blood indium was only below the quantitative lower limit. However, in other groups whole blood indium level was significantly higher than serum indium level (P<0.05) and even was two-fold in the high exposure group.@*Conclusion@#The detection of whole blood indium is more sensitive than that of serum indium, which can reflect the internal exposure level more accurately in exposure population. Therefore, the whole blood indium is of more important referential value to health examination and poisoning diagnosis in the population exposed to indium and its compounds.
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Objective@#To summarize the clinical characteristics of occupational asthma and provide a basis for revising the diagnosis of occupational asthma in China.@*Methods@#Taking "occupational asthma" , "occupational bronchial asthma" and "bronchial provocation test at work site" as key words, the case reports of occupational asthma in China were retrieved. The general data, latent period, allergen, clinical manifestation, and diagnostic methods were analyzed.@*Results@#A total 318 cases from 14 published literatures were reported.The incidence of male and female is basically similar. The average age of onset is 38 years, and the latent period is from 2 months to 19 years. The top 3 allergens were isocyanates, penicillin and cephalosporins, formaldehyde. During the diagnosis process, 48.8% of the patients were diagnosed by bronchial provocation test, and 19 cases were diagnosed according to the specific IgE antibody. Only 1 case was diagnosed according to the specific skin test.@*Conclusion@#The etiological diagnosis of occupational asthma is not easy. Nearly half of the patients in our country have been diagnosed as occupational asthma by bronchial provocation test at work site. How to identify the relationship between occupational exposure and the occurrence of asthma is one of the main problems we need to solve.
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OBJECTIVE: To analyze chromosome damage and its possible influencing factors in patients with occupational chronic benzene poisoning. METHODS: Fifty patients with occupational chronic benzene poisoning were selected as chronic benzene poisoning group,and 53 workers without occupational exposure to benzene and other toxic substances were chosen as control group by using convenience sampling method. Questionnaire and routine blood test were conducted on all study subjects. Micronucleus rate test was performed by micronucleus blocking cytokinesis assay. RESULTS: Peripheral blood tests of chronic benzene poisoning group showed significantly reduced hemoglobin level,counts of red blood cells,white blood cells,platelets,lymphocytes and neutrophils( P < 0. 01),and higher lymphocyte micronucleus rates compared to control group( !: 6. 26‰ vs 3. 91‰,P < 0. 01). The proportion of increased lymphocyte micronucleus rate in chromic benzene poisoning group was also higher than that in control group( 46. 0% vs 5. 7%,P < 0. 01). The multivariate Poisson analysis results indicated that the time after disengagement from benzene exposure was the influencing factor of micronucleus rate in chronic benzene poisoning group( P < 0. 05),after adjusting the confounding factors of gender,age,smoking status,alcohol drinking status and working age of benzene exposure. CONCLUSION: Occupational chronic benzene poisoning leads to increase of chromosome damage in lymphocytes of patients. The time after disengagement from benzene exposure was positively correlated with chromosome damage.
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Objective@#To study the electrophysiological changes and pathological characteristics of peripheral nerve in rats exposed to 1-bromopropane through chronic inhalation.@*Methods@#40 male SD rats were randomed divided into 4 groups, and exposed to 1-bromopropane vapor at concentrations of 1 000 mg/m3, 2 000 mg/m3, 4 000 mg/m3 and fresh air respectively, 6 hours per day, 5 days per week for 12 weeks. The changes of nerve conduction velocity (NCV) , electromyography (EMG) and pathology were observed.@*Results@#After 4 weeks of exposure, the body weights of high dose group are lower than that of the control group. Compared with the control group, the high and medium dose group have a decline in MCV and CMAPs, while SCV and SNAPs descend in the high dose group (P<0.05) . The EMG examination showed that there are denervation changes in high dose group. Sciatic nerve biopsy observed by electron microscope showed that axonal degeneration and demyelination coexist in the rats exposed to high concentration.@*Conclusion@#Chronic inhalation of 1-bromopropane at the concentration of 4 000 mg/m3 can cause peripheral nerve injury, which is characterized by axonal degeneration and demyelination. Axonal degeneration is the main pathological change.
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Objective@#To observe the effect of nerve growth factor (NGF) and Mecobalamin on chronic peripheral neuropathy in rats induced by 1-bromopropane.@*Methods@#36 male SD rats were exposed to 1-bromopropane vapor at concentrations of 4 000 mg/m3, 6 hours per day, 5 days per week for 12 weeks. The rats were randomed divided into 4 groups, and treated by Mecobalamin for 300 μg/kg qd, NGF for 40 μg/kg qd, Mecobalamin+NGF with the dose as mentioned above, respecively. The control group were fed in normal condition. The changes of Sciatic nerve conduction velocity (NCV) , electromyography (EMG) and pathology were observed 30 days later.@*Results@#The nerve conduction velocity were decreased in all the rats. Compared with the control group, the motor nerve conduction velocity (MCV) was improved in group Mecobalamin and group Mecobalamin+NGF, The difference was statistically significant, as the sensory nerve conduction velocity (SCV) was improved only in group Mecobalamin+NGF. Sciatic nerve biopsy observed by electron microscope showed that myelinated nerve fibers were obvious swelling, lamellar separation, partial myelin vacuolization, and axonal degeneration. After treatment with exogenous nerve growth factor, the number and severity of damaged nerve fibers were restored.@*Conclusion@#Exogenous nerve growth factor contributes to the recovery of peripheral nerve damage induced by 1-bromopropane.
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Objective@#To establish an animal model of hard metal lung disease (HMLD) in rats, and to screen the indications for diagnosis of HMLD.@*Methods@#The rats were randomly divided into 5 groups, each group included 8 rats: saline group, pure cobalt group, pure tungsten carbide group, silica group and hard metal (HM) group. 10 mg subjects were administered in each group by using the pulmonary endotracheal tube. After 8 week, the lung CT scan and lung tissue pathology were observed, the serum and bronchoalveolar lavage fluid (BALF) were collected for KL-6, TGF-beta1 and TGF-beta2.@*Results@#The lung tissue structure of HM group was destroyed, a large number of nuclear giant cells and epithelial like cells appeared in the stroma, and uncommon CT scan images appeared in the lung. KL-6, TGF-beta1, TGF-beta2 expression in each group was not the same, the difference was statistically significant (P<0.05) . The expression of KL-6 and TGF-beta1 in serum was not identical in all the groups, the difference was statistically significant (P<0.05) . The expression of TGF-beta2 had no significant difference between the groups (P>0.05) .@*Conclusion@#Rats can be successfully established HMLD model, rats in vivo lung CT scan images appear abnormal, which are provided with assistant diagnostic value for HMLD. The expression of KL-6 and TGF-beta2 in serum and BALF on HMLD rats are not highly specific, and TGF-beta1 has reference value in the rat HMLD auxiliary diagnosis.
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<p><b>OBJECTIVE</b>To investigate the effects of different concentrations of indium chloride (InCl3) on the proliferation of human lung epithelial (Beas-2B) cells and its potential mechanism.</p><p><b>METHODS</b>Beas-2B cells were exposed to different concentrations of InCl3 (0.3, 1.0, 3.0, 10.0, 30.0, 90.0, 270.0, and 810.0 µmol/L) for 24, 48, and 72 h, respectively. The effects of InCl3 on cell proliferation were determined by the CCK-8 assay. The effects of InCl3 on apoptosis were evaluated using annexin V-PI staining followed by flow cytometry. The level of intracellular reactive oxygen species (ROS) in Beas-2B cells after exposure to InCl3 was determined using 2', 7'-dichlorofluorescein diacetate labeling followed by flow cytometry.</p><p><b>RESULTS</b>Compared with the control group, InCl3 at a relatively low concentration (0.3~3.0 µmol/L) significantly promoted cell proliferation (P < 0.05), while InCl3 at a relatively high concentration (30.0~80.0 µmol/L) significantly inhibited cell proliferation after 72 h (P < 0.05). InCl3 at a concentration of 0.3 µmol/L failed to induce apoptosis within 72 h; however, InCl3 at a concentration of 30.0 or 810.0 µmol/L induced substantial early apoptosis after 72 h. Compared with the control group, cells exposed to 0.3 µmol/L InCl3 showed a slight decrease in the level of intracellular ROS within 72 h, while cells exposed to 30.0 or 810.0 µmol/L InCl3 showed a significant increase in the level of intracellular ROS after 72 h (P < 0.05).</p><p><b>CONCLUSION</b>At a low concentration, InCl3 stimulates cell proliferation by reducing intracellular ROS. However, at a high concentration, InCl3 inhibits cell viability by elevating intracellular ROS and inducing apoptosis.</p>
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Humans , Apoptosis , Cell Proliferation , Cell Survival , Epithelial Cells , Flow Cytometry , Indium , Toxicity , Reactive Oxygen SpeciesABSTRACT
<p><b>OBJECTIVE</b>To discuss the clinical features of Indium-related lung diseases.</p><p><b>METHODS</b>We searched database of Chinese and Pubmed, Embase, Web of Science to collect research data of indium-related lung diseases from Jan. 1998 to Aprl. 2014. Case reports, exposure histories and lab results were analysed and summarized.</p><p><b>RESULTS</b>1998 to Mar 2010, ten cases of indium-related lung diseases were published. Seven cases of interstitial pneumonia were reported in Japan, two cases of pulmonary alveolar proteinosis (PAP) were reported in the USA and one case of PAP reported in China. Chest computer tomography (CT) showed diffuse or local ground glass appearance (GGA) in 8 cases, 3 of which also showed centrilobular nodules; Pulmonary function test were normal only in one out of 8 cases. Cholesterol clefts were found in 4 cases of interstitial pneumonia. 3 cases died among 6 cases who were followed-up.</p><p><b>CONCLUSIONS</b>Occupational exposure to indium compounds are contributory to different pulmonary diseases, which are composed of interstitial pneumonia and pulmonary alveolar proteinosis. The relationships between In-C, In-S and these pulmonary diseases are unclear.</p>
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Humans , China , Glass , Indium , Toxicity , Japan , Lung Diseases, Interstitial , Pathology , Occupational Exposure , Pulmonary Alveolar Proteinosis , Pathology , Respiratory Function Tests , Tomography, X-Ray ComputedABSTRACT
<p><b>OBJECTIVE</b>To study the character of welder's pneumoconiosis on CT, pathology, and lung function.</p><p><b>METHODS</b>To contrast 185 welder's pneumoconiosis and 115 silicosis on CT, pathology, and clinical characters which were diagnosed between Jan 2008 and Dec 2013. Chest X-ray and lung function of 39 welder's pneumoconiosis patients were followed up after diagnosed 4~6 years later.</p><p><b>RESULTS</b>Average age and working years of welder's pneumoconiosis were 36.7 and 11.5, less than silicosis patients 58.8 and 22.1, respectively (P<0.05). Of all 185 welder's pneumoconiosis 98.4% were of stage I and no stage III, while in silicosis group stage I, stage II and stage III were 56.5%, 22.6% and 20.9%, respectively. The ratio differences between the two groups were statistically significant,P<0.05. 82.7% of welder's pneumoconiosis patients were observed pathologically moderate or above dust deposition in lung tissue while interstitial fibrosis level was just mild (97.6% patients) or no fibrosis (2.4% patients). By contrast, 60.0% silicosis patients pathologically showed moderate or above dust deposition while 77.8% were of moderate or above fibrosis. CT findings in welder' s pneumoconiosis were diffuse branching linear structure (38.9%), low density consistent size centrilobular micronodules (19.5%), or both (30.8%). Poorly-defined ground-glass attenuation centrilobular micronodules or widely ground glass shadow were observed in 6.4% welder's pneumoconiosis patents. 30.8% patients failed to reach the original stage when 39 welder's pneumoconiosis followed up chest radiograph.</p><p><b>CONCLUSION</b>Changes in welder's lung caused by welding fume were not only siderosis, but also interstitial fibrosis.</p>