Surveillance of respiratory diseases among construction and trade workers at Department of Energy nuclear sites
Surveillance of respiratory diseases among construction and trade workers at Department of Energy nuclear sites
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DOI：
10.1002/ajim.10226
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发表时间：
2003-06-01
影响因子：
3.5
通讯作者：
Ringen, K
中科院分区：
文献类型：
--
作者：
Dement, JM;Welch, L;Ringen, K
1996年和1997年，美国能源部（DOE）的三个核武器设施（汉福德核保留区、橡树岭和萨凡纳河遗址）启动了医疗筛查项目，以评估目前和以前的建筑工人是否有患职业病的重大风险。本报告的重点是2001年9月30日之前参加筛查项目的工人中与接触石棉和二氧化硅有关的尘肺病。方法提供详细的工作和暴露史，并进行呼吸系统检查，包括呼吸史和症状问卷、胸片和肺活量测定。采用分层和多变量logistic回归分析，在控制年龄、种族、性别和建筑行业其他工作等潜在混杂因素的同时，探讨DOE工作时间和暴露频率对疾病风险的影响。结果在2602名工人中，25.2%的人表现出一种或多种符合国际劳工组织标准的胸片改变，42.7%的人表现出一种或多种肺功能缺陷。根据国际劳工组织（ILO）的标准，实质改变的总体发生率为5.4%（浸润1/0或更大）。在logistic回归模型中，在汉福德或萨凡纳河工作6至20年的工人患实质性疾病的比值比为2.6(95%置信区间(CI) = 1.0-6.6)，而工作超过35年的工人患实质性疾病的比值比增加到3.6 (95% CI = 1.1-11.6)，报告常规暴露于石棉或二氧化硅的工人的风险增加。结论：鉴于工人的疾病进展风险和石棉相关恶性肿瘤风险增加，对工人的持续监测很重要。戒烟计划也应列为优先事项，并加强前吸烟者的持续戒烟。虽然观察到的呼吸系统疾病模式在很大程度上反映了过去的暴露，但这些发现表明，美国能源部需要继续审查涉及维护、修理、翻新和拆除等工作任务的工业卫生控制计划。(C) 2003 Wiley-Liss, Inc。
Background Medical screening programs were begun in 1996 and 1997 at three Department of Energy (DOE) nuclear weapons facilities (Hanford Nuclear Reservation, Oak Ridge, and the Savannah River Site) to evaluate whether current and former construction workers are at significant risk for occupational illnesses. The focus of this report is pneumoconiosis associated with exposures to asbestos and silica among workers enrolled in the screening programs through September 30, 2001.Methods Workers provided a detailed work and exposure history and underwent a respiratory examination, which included a respiratory history and symptom questionnaire, a posterior-anterior (P-A) chest radiograph, and spirometry. Both stratified and multivariate logistic regression analyses were used to explore the risk of disease by duration of DOE employment and frequency of exposure, while controlling for potential confounders such as age, race, sex, and other work in the construction and building trades.Results Of the 2,602 workers, 25.2% showed one or more chest X-ray changes by ILO criteria and 42.7% demonstrated one or more pulmonary function defects. The overall prevalence of parenchymal changes by ILO criteria (profusion 1/0 or greater) was 5.4%. In the logistic regression models, the odds ratio for parenchymal disease was 2.6 (95% confidence interval (CI) = 1.0-6.6) for workers employed 6 to 20 years at Hanford or Savannah River and increased to 3.6 (95% CI = 1.1-11.6) for workers employed more than 35 years, with additional incremental risks for workers reporting routine exposures to asbestos or silica.Conclusions Continued surveillance of workers is important given their increased risk of disease progression and their risk for asbestos related malignancies. Smoking cessation programs should also be high priority and continued abstinence for former smokers reinforced. Although the observed respiratory disease patterns are largely reflective of past exposures, these findings suggest that DOE needs to continue to review industrial hygiene control programs for work tasks involving maintenance, repair, renovation, and demolition. (C) 2003 Wiley-Liss, Inc.