FYI:職業性呼吸器疾患の動向/配偶者におされてスリップ
環境中の物質が人体に侵入する主たる経路である呼吸器では,吸入された10 μm以下のエアロゾルは気管・気管支に沈着し,さまざまな呼吸器疾患を誘発する要因となり得る.職場環境での吸入曝露によって発症する職業性呼吸器疾患は,喘息や過敏性肺炎のように,初回曝露から発症までの期間が比較的短いもの,じん肺や中皮腫のように,曝露から発症まで数十年を要するものがある.いずれも,曝露防止により発症を防ぎ得る疾患ではあるが,近年は,新たな化学物質や工業材料の開発によって,これまでの曝露対策では対応困難な例も発生している.職業性呼吸器疾患の予防には,労働者の啓発・教育はもちろん,有害性の高い物質の使用回避(代替),適正な作業環境や作業態様の管理を行い,曝露対策を徹底することが重要である.また,労働者の健康管理を継続的に展開することも重要である.
・↑の論文は基本的なことと最近の日本の動向をかかれていますが、ちょっと不満なのは海外の動向を書かれていないこと。職業・環境性疾患の論文読むと結構ジーンズ作業者や人造石加工者の問題がめにつきます。↓の論文はその一例。
Silicosis in Turkish denim sandblasters
https://academic.oup.com/occmed/article/56/8/554/1464960
【Abstract】
Background Sandblasting of jeans in small Turkish workshops has recently been recognized as a cause of silicosis.
Case series Between August 2004 and March 2006, we admitted 16 young men with a history of working in small workplaces producing sandblasted jeans. Of these, 14 presented with respiratory symptoms and the remaining two through awareness of their work colleagues. In the first two cases, open-lung biopsy was required to confirm the diagnosis of silicosis. Later cases were diagnosed through a combination of their work history and the clinical and radiological findings. The mean age at presentation was 23 years with mean duration of employment as a sandblaster being 3 years. The first two cases died and the remainder, except two, are still receiving treatment.
Conclusion The production of sandblasted jeans in small uncontrolled workplaces may entail significant exposure to silica and the development of rapidly fatal silicosis. Urgent action is required to prevent further cases and mortality.
Artificial Stone Associated Silicosis: A Systematic Review
Veruscka Leso, et al.https://www.mdpi.com/1660-4601/16/4/568
【Abstract】
Silicosis is a progressive fibrotic lung disease that is caused by the inhalation of respirable crystalline silica. Due to its high silica content, artificial stone (AS) can become a possible source of hazardous dust exposure for workers that are employed in the manufacturing, finishing, and installing of AS countertops. Therefore, the aim of this review was to verify the association between AS derived silica exposure and silicosis development, and also then define the pathological characteristics of the disease in relation to specific work practices and preventive and protective measures that were adopted in the workplace. A systematic review of articles available on Pubmed, Scopus, and Isi Web of Knowledge databases was performed. Although the characteristics of AS-associated silicosis were comparable to those that were reported for the disease in traditional silica exposure settings, some critical issues emerged concerning the general lack of suitable strategies for assessing/managing silica risks in these innovative occupational fields. Further research that is designed to assess the hazardous properties of AS dusts, levels of exposure in workplaces, and the effectiveness of protective equipment appears to be needed to increase awareness concerning AS risks and induce employers, employees, and all factory figures that are engaged in prevention to take action to define/adopt proper measures to protect the health of exposed workers.
・最初にご紹介した内科学会の論文の本文最後に、「内科医は呼吸器疾患患者を診察する際に、職業・職歴を聴くのみではなく、一度は職業性疾患を疑って確認することが重要である。」とかかれていますが、これはどういう意味でしょう?職歴を形式的に訊いて記録するだけではなく、きちんと鑑別診断にあげて、診察・検査を進めていくべきだということでしょうか?(「カルテあとからレビューして、ちゃんとここに職歴書いているのになんで鑑別疾患にいれなんだん?」ということなのでしょうかね?)
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