职业健康是健康中国战略的重要组成部分.随着职业卫生专业技术发展,我国逐步建立了较为健全的职业卫生工作体系,极大限度地降低了职业病的发生、发展.然而,随着我国工业化进程不断推进,职业病危害问题日渐突出,造成了接触人员基数大、职业病危害因素复杂等的现状,职业病防治工作面临的形势依然严峻.基于现有文献、政府文件以及实际工作情况,着重分析了我国现阶段职业卫生工作情况,提出问题,并探讨了新时代背景下的职业卫生工作相关法律体系、工作理论体系与机制、监管机制、职业病防治理念、人才培养、技术服务体系等的应对策略.

BackgroundPrevious research indicated that isomers and alternatives of per- and polyfluoroalkyl substances (PFAS) probably disturb glucose metabolism; however, current epidemiological evidence on the associations of PFAS with fasting blood glucose is inconsistent. Besides, studies on the joint association of multiple components of PFAS and fasting blood glucose as well as the key component are scarce. ObjectiveTo evaluate the associations of PFAS isomers and alternatives with fasting blood glucose and their joint effects, as well as identify the key component among population without glucose metabolism problems. MethodsWe selected 923 adults without glucose metabolism problems or missing data from the Isomers of C8 Health Project in China (2015—2016). Serum PFAS isomers and alternatives and fasting blood glucose were measured using ultra-performance liquid chromatography coupled with tandem mass spectrometry (UPLC-MS/MS) and automatic biochemical analyzer. We applied multiple linear regression to explore the associations of 16 pollutants which were detected among over 80% participants with fasting blood glucose. Meanwhile, we utilized qgcomp and Bayesian kernel machine regression (BKMR) models to explore the joint effects of PFAS isomers and alternatives mixture on target outcome indicators and identify the key component. ResultsThe average age among the 923 participants in this study was (62.4±13.8) years old, including 472 men (51.1%) and 451 women (48.9%). Among selected PFAS isomers and alternatives, the highest serum concentration was ∑3+4+5m-PFOS (perfluoro-3/4/5-methylheptanesulfonate) with a median concentration of 10.20 ng·mL−1. The concentrations of linear perfluorooctane sulfonate (n-PFOS, 9.61 ng·mL−1), perfluorooctanoic acid (PFOA, 4.55 ng·mL−1), linear perfluorohexane sulfonic acid (n-PFHxS, 2.48 ng·mL−1), 6:2 chlorinated polyfluorinated ethersulfonic acid (6:2 Cl-PFESA, 1.90 ng·mL−1), perfluoro-6-methylheptanesulfonate (iso-PFOS, 1.85 ng·mL−1), perfluorobutanoic acid (PFBA, 1.81 ng·mL−1), perfluorinated n-nonanoic acid (PFNA, 1.39 ng·mL−1), and perfluoro-1-methylheptanesulfonate (1m-PFOS, 1.27 ng·mL−1) were higher than 1.00 ng·mL−1. After being adjusted for selected confounders, PFAS isomers and alternatives were positively associated with fasting blood glucose. With 1 ln unit concentration increment of 6:2 Cl-PFESA and PFNA, the estimated changes of fasting blood glucose were 0.18 (95%CI: 0.13, 0.23) mmol·L−1 and 0.24 (95%CI: 0.18, 0.30) mmol·L−1, respectively. The multi-pollutant models indicated a joint association of PFAS isomers and alternatives mixture with fasting blood glucose. The BKMR models reveals that as the quantiles of mixture elevated from the 50th to the 75th percentile, the values of fasting blood glucose increased 0.25 (95%CI: 0.21, 0.30) mmol·L−1, and the posterior inclusion probability of PFNA was 0.92, implying that PFNA was the key component. ConclusionPFAS isomers and alternatives are positively associated with fasting blood glucose. PFNA is the key component of the joint association.

[背景]绿地空间暴露与儿童青少年过敏性鼻炎(AR)的关联性研究多在发达国家开展,并且结论并不一致.[目的]应用街景数据探讨绿地空间暴露与我国儿童青少年AR患病的关联.[方法]2012—2013年,在我国东北地区3个城市40868名2～17岁儿童青少年中开展了1项横断面研究,其中男孩20886人(51.1％)、女孩19982人(48.9％),通过问卷调查获得AR患病的相关信息.应用人工智能方法提取2012—2013年腾讯街景图像中的绿地信息(包括树木和草地等),计算研究对象所在学校附近(800 m和1000 m缓冲区)的绿景指数(GVI),并将其作为绿地空间暴露的评价指标.应用混合效应logistic回归模型评估GVI每增加1个四分位间距(IQR),AR患病的比值比(OR).此外,根据PM2.5暴露情况,将研究对象分为PM2.5低暴露组(≤56.23μg·m–3)和高暴露组(>56.23μg·m–3),并探讨PM2.5是否在GVI与AR的关联中发挥效应修正作用.[结果]研究对象的年龄为(10.40±3.68)岁,其中3963(9.7％)人曾经被医生诊断为AR.调整协变量后,在800 m缓冲区,树木和总绿地的GVI每增加1个IQR(树木:0.031;总绿地:0.029),AR的OR及95％CI值分别降低15％(10％～19％)和14％(10％～19％).PM2.5与GVI的交互作用存在统计学意义(P<0.1),在PM2.5低暴露组中树木和总绿地的GVI与AR患病率降低相关,而在PM2.5高暴露组则无关联.应用1000 m缓冲区GVI进行敏感性分析,其所得结果与800 m缓冲区基本一致.[结论]绿地特别是树木的覆盖率增加与儿童青少年AR患病风险降低相关,并且这种相关关系可能在低浓度PM2.5的地区更为明显.

目的 对深圳市某高尔夫球杆生产企业在正常生产期间出现的53例职业性手臂振动病(occupational hand-arm vibration disease,OHAVD)进行职业卫生学分析,为高尔夫生产企业的职业卫生防护提供科学依据.方法 通过现场职业卫生调查及检测检验,结合职业健康检查、职业病鉴定结果等,对某高尔夫球杆生产企业2013-2016年期间发生的职业性手传振动病患者进行调查分析.结果 该厂共有生产员工1 772人,手传振动工人职业接触率占23.87％,主要以木杆头、铁杆头制作为主;对47个手传振动岗位的ahw(4)进行检测,26个岗位超标,不合格率为55.32％,但超标岗位均未超过9 m/s2;53例OHAVD患者,轻度51例(96.22％),中度2例(3.77％),患者症状普遍较轻;经劳动能力鉴定,2例患者劳动能力为六级(3.77％),其他均为八级(96.22％).结论 该企业工作场所手传振动岗位存在超标超时严重,企业存在设备布局不合理,无有效的减振措施及个体防护等问题.

目的 为保障劳动者身体健康,本文对薄膜晶体管液晶显示器(thin film transistor-liquid crystal display,TFT-LCD)生产过程的职业病危害因素进行详细的识别与分析. 方法 资料来源于两家国内TFT-LCD生产厂家.调查内容主要包括工作场所职业卫生学调查、职业卫生管理、职业健康监护、职业病危害防护设施、个人防护用品使用情况等.①依照《职业病危害因素分类目录》识别工作场所存在的职业病危害因素;②按照国家现行有效的工作场所职业病危害因素标准检测方法进行采样、现场物理因素测量和化学性(含粉尘)有害因素的实验室检测. 结果 两厂共计劳动定员3 690人,其中接触职业性有害因素1 216人,占32.95％.存在100多种职业性危害因素,对其中有限值和检测方法标准的因素进行检测,除3个噪声岗位超标外,其余均小于0.5个职业接触限值.职业健康监护未发现疑似职业病. 结论 TFT-LCD属于计算机、通讯和其他电子设备制造业(电子器件及其他电子器件制造).工艺复杂,存在的职业病危害因素品种多,既有致癌与生殖毒性物质,也有窒息性、剧毒气体,加上很多化学物质成分保密,尽管所测有害因素都符合国家职业接触限值,但也应该加强工程控制、过程管理与个人防护和职业健康监护.对TFT-LCD此类微电子生产厂家,不能单纯凭传统的职业卫生技术评定其职业病危害风险,而要从全面识别、全面分析的角度详细分析和识别职业病危害,才能确保劳动者身体健康.

目的了解某公司噪声作业工人职业健康检查情况,分析噪声对作业工人健康的影响。方法对某公司接触噪声作业的145名员工与未接触噪声作业的110名员工进行对照分析,对两组的心电图、血压、电测听等检查结果进行比较。结果观察两组高血压患病率、心电图异常率高于对照组,两者差异有显著性(P<0.05),且随工龄的延长而呈上升趋势。听力损伤也高于对照组,两者差异有显著性(P<0.05),且随工龄的延长而呈上升趋势。结论抓住噪声源头的治理,给员工佩带防护耳塞或耳罩,定期组织员工进行职业健康检查,提高他们自身素质。