Cocco P
Dipartimento di Sanità Pubblica-Sezione di Medicina del Lavoro, Università di Cagliari.
G Ital Med Lav Ergon. 2003 Jul-Sep;25(3):420-1.
To assess occupational exposure to solvents in the EPILYMPH multicentre case-control study on lymphoma, we combined experts assessment, based on detailed description of work tasks from questionnaires, with the use of job-exposure matrices (jem). Whenever occupations and/or industries conveying exposure to occupational risk factors for lymphoma occur in their work history, the interviewer selects the respective questionnaire in a set of 15 special questionnaires and applies it to the study subject. All jobs lasting one year or more in the work histories are coded using the 1968 ILO ISCO, and the 1996 EEC Classification of Economic activities (NACE). A priori jems for 3 categories of solvents (solvents in general, chlorinated aliphatic hydrocarbons and benzene-toluene-xylene combination) and 10 individual agents have been constructed based on the same coding systems, by which each occupationa/industry combination receives a unique score for confidence and intensity of exposure to each agent and group of solvents. Trained industrial hygienists (IH's) in each participating country examine the general and special questionnaires and classify three indices of exposure for each agent under scrutiny: confidence, which represents the IH degree of certainty that the worker has been exposed to the agent; frequency, which is expressed in a 4-step scale according to the proportion of working time involving contact with the agent; and intensity, which is also expressed in a scale, defined by quantitative cut-points, when available, or benchmark occupations, when no quantitative information is available from the questionnaires. The IH finally notes his degree of reliance on his own exposure estimate. The IH supports his exposure assessment with confidence and intensity scores provided by the jem when questionnaire information is so poor that it does not provide any clue about exposure, or he relies poorly on his own exposure estimate. Such a procedure is conceptually alike to statistical procedures to fill missing data in a given series.
在淋巴瘤的EPILYMPH多中心病例对照研究中,为评估职业性溶剂暴露情况,我们将基于问卷中工作任务详细描述的专家评估与工作暴露矩阵(JEM)的使用相结合。只要在工作经历中出现涉及淋巴瘤职业风险因素暴露的职业和/或行业,访谈者就在一套15份特殊问卷中选择相应问卷并应用于研究对象。工作经历中所有持续一年或更长时间的工作都使用1968年国际劳工组织国际标准职业分类(ISCO)和1996年欧洲经济共同体经济活动分类(NACE)进行编码。基于相同的编码系统,构建了3类溶剂(一般溶剂、氯代脂肪烃和苯-甲苯-二甲苯混合物)和10种个体物质的先验JEM,据此每个职业/行业组合都获得针对每种物质和溶剂组的暴露置信度和强度的唯一分数。每个参与国家的受过培训的工业卫生学家(IH)检查一般问卷和特殊问卷,并对每种受审查物质的三个暴露指标进行分类:置信度,代表IH对工人接触该物质的确定程度;频率,根据涉及接触该物质的工作时间比例以4级量表表示;强度,当有可用的定量切点时,也以量表表示,或在问卷没有定量信息时,以基准职业表示。IH最后记录他对自己暴露估计的依赖程度。当问卷信息非常差以至于无法提供任何暴露线索,或者他对自己的暴露估计依赖程度很低时,IH会用JEM提供的置信度和强度分数来支持他的暴露评估。这样的程序在概念上类似于在给定系列中填充缺失数据的统计程序。