柳江流域饮用水源地重金属污染与健康风险评价

为说明柳江流域饮用水源地的重金属元素含量特征及饮用水水质对人体健康的潜在危害,于2016年1~12月对柳江干流及主要支流的水体进行常规水质指标和Cd、As、Cr、Hg、Zn、Cu、Pb、Fe、Mn等金属元素进行分析检测,并采用美国EPA推荐使用的健康风险评价模型对饮用水源地的健康风险进行评价.结果表明,Cd、As、Cr、Zn、Cu、Pb、Fe、Mn含量未超过我国地表水环境质量标准（GB 3838-2002）的限值,Hg含量存在超标.对重金属含量进行Pearson相关性分析,其中Cd、Pb、As与Fe可能具有相似的来源,Cu、Cr、Hg、Zn之间污染具有多源性,9种重金属含量与pH值间均不存在显著相关性.柳江流域饮用水源地致癌重金属元素健康风险成人和儿童分别为4.52E-04 a^-1和5.91E-04 a^-1,非致癌健康风险成人和儿童分别为8.96E-09 a^-1和1.14E-08 a^-1.致癌重金属Cr、As、Cd通过饮水途径所造成的人均年健康风险分别表现为Cr > As > Cd,风险值范围为3.58E-06~1.21E-04 a^-1,Cr和As的风险值大于ICRP所推荐的风险水平5.0×10^-5 a^-1.该研究区内重金属元素非致癌健康风险值范围为3.53E-12~2.87E-09 a^-1,均在EPA推荐的可接受水平内,初步认为不会对人体健康产生明显危害.流域主要健康风险来源于致癌物.Cr和As是柳江流域水环境产生健康风险的主要污染物,应当优先列为柳江流域水环境风险管理的主要对象.     

巢湖水体和水产品中多环芳烃的含量与健康风险

利用GC-MS测定了巢湖水体15个样品及9种主要水产品中16种优控多环芳烃(PAHs)的含量,并用美国环保局(USEPA)推荐的健康风险评价模型估算了巢湖地区居民由于饮水、洗澡及食用水产品造成的PAHs暴露量.在此基础上,利用概率风险评价和蒙特卡罗模拟方法分析了巢湖水体与水产品中PAHs的健康风险及其不确定性.研究结果表明,巢湖水体中16种优控PAHs总含量(PAH16)范围为95.63～370.13ng·L-1,平均为(170.72 ±70.79) ng·L-1,BaP当量浓度(Bapeq)为(1.43±0.79) ng·L-1;水产品中PAH16的干重含量范围为129.33 ～575.31 ng·g-1,均值为(320.93±147.50) ng·g-1,BaP当量浓度为(4.67±6.68) ng·g-1.巢湖地区居民由于饮水和洗浴造成的PAH16暴露量分别为(5.76±2.39)×10-3 ng·kg-1·d-1和(25.08±10.40)×10-3 ng·kg-1·d-1,城镇与农村居民食用水产品造成的PAH16暴露量分别为(190.86±84.17) ng· kg-1· d-1和(75.88±33.47) ng·kg-1·d-1;水产品食用是巢湖地区居民PAHs暴露的主要途径.洗浴和饮水造成的PAH16暴露风险分别为(6.33±4.70)×10-9 a-1和(4.32±2.47) ×10-7 a-1,城镇与农村居民食用水产品造成的PAH16暴露风险分别为(3.17±3.79)×10-5 a-1和(1.25±1.50) ×10-5 a-1;居民食用水产的PAH16暴露风险高于USEPA建议的可接受风险(1.0×10-6 a-1),存在一定的致癌风险.水产品食用风险的不确定度较高,Bap当量浓度是影响风险评估不确定性的主要因素.     

Preventing falls among seniors: the way forward

There is a growing body of research about the etiology and prevention of falls. However, the persistently high incidence of falls among seniors calls for renewed efforts to develop, test, implement, and scale-up fall prevention strategies for older adults. This paper considers advances in the field and describes three priority areas for generating research and translating knowledge on fall prevention. Clinical practice guidelines, systems change approaches and environmental risk factors are discussed. Recommendations include transcending our health sector view of the fall prevention problem, supporting comparative research on system-oriented approaches to fall prevention, and examining ways to sustain and scale-up fall prevention efforts.     

个体防护行业创建“标准化良好行为企业”探讨

本文主要介绍了个体防护行业创建“标准化良好行为企业”的重要性以及与其他管理体系的整合,同时详细介绍了创建“标准化良好行为企业”的程序以及标准体系建立的依据、原则、方式等,以促进个体防护行业管理水平、产品质量水平的提升,使人们的安全与健康得到有效保护。     

A multiple additive regression tree analysis of three exposure measures during Hurricane Katrina

This paper analyses structural and personal exposure to Hurricane Katrina. Structural exposure is measured by flood height and building damage; personal exposure is measured by the locations of 911 calls made during the response. Using these variables, this paper characterises the geography of exposure and also demonstrates the utility of a robust analytical approach in understanding health‐related challenges to disadvantaged populations during recovery. Analysis is conducted using a contemporary statistical approach, a multiple additive regression tree (MART), which displays considerable improvement over traditional regression analysis. By using MART, the percentage of improvement in R‐squares over standard multiple linear regression ranges from about 62 to more than 100 per cent. The most revealing finding is the modelled verification that African Americans experienced disproportionate exposure in both structural and personal contexts. Given the impact of exposure to health outcomes, this finding has implications for understanding the long‐term health challenges facing this population.     

Rebuilding and strengthening health systems and providing basic health services in fragile states

The international community has compelling humanitarian, political, security and economic reasons to engage in rebuilding and strengthening health systems in fragile states. Improvements in health services and systems help to strengthen civil society and to restore legitimacy to governments. Effective engagement with fragile states to inform the design of health programmes and selection of interventions depends on donor coordination and an understanding of health system challenges. Planning requires consideration of allocation (services to be delivered), production (organisation of services), distribution (beneficiaries of services) and financing. The criteria for selecting interventions are: their impact on major health problems; effectiveness; the possibility of scale-up; equity; and sustainability. There are various options for financing and models of engagement, but support should always combine short-term relief with longer-term development. Stakeholders should aim not only to save lives and protect health but also to bolster nations' ability to deliver good-quality services in the long run.     

肾移植患者社会支持对其心理健康影响的研究进展

综述了影响肾移植患者心理健康的原因以及社会支持与心理健康的相关性,并探讨通过社会支持提高肾移植患者心理健康水平的途径.从而提示护理工作者在工作中应尽可能调动肾移植患者本人、家庭成员及社会的主观能动性,以提高肾移植患者的心理健康水平.     

Occupational Health Care in Small and Medium-Sized Enterprises—How Many Doctors Do We Need and How Do We Ensure Good Care?

The translation of the framework directive 89/391/EEC (Council Directive 89/391/EEC) into national law aims at supplying occupational protection and health care to all employees of large, small, and medium-sized enterprises (SMEs) likewise, depending on assessed exposure. Prior incomplete protection of the German workforce with bias against the SMEs requires an assessment of quantitative and qualitative adequacy of present occupational health care practice and also of future needs.

Therefore, the Federal Institute for Occupational Safety and Health of Germany initiated a study to evaluate the present state of occupational health care in 4 regions with different geographic and economic structure. Based on these data the future demand for adequately trained occupational physicians will be estimated by employing a statistical method that allows for including a large number of modifying variables (economic development, demographic change, etc.).

Expected result of the applied technique are the estimated minimal and maximal number of occupational physicians that have to be trained to meet future demand. In the same study models of best practice will be identified and evaluated for general application. The project started in October 1997 and will be finished by January 2000.     

Working Conditions in Small Private Enterprises in Poland

The study deals with working conditions in small private enterprises in Poland. Data come from 50 small enterprises from the Warsaw area. Information about the evaluation of working conditions and the existence of programmes for their improvement was gathered with the help of questionnaires addressed to employees and employers. The results constitute a ‘photograph’ of the Polish reality at the beginning of its transition from planned to market economy. The study revealed a lack of programmes for the improvement of working conditions in a significant number of the enterprises studied as well as little interest in occupational safety on the part of employers (owners).

The study also revealed that all decisions—including those about the improvement of working conditions—were made by employers. Hence, the need for the widest possible dissemination of knowledge on occupational safety and the protection of human in the working environment with particular stress put on employers. Employers who are knowledgeable in this field and who are aware of its importance can significantly influence the improvement of working conditions in small enterprises.