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WHO流行病学调查第一阶段技术报告

WHO流行病学调查第一阶段技术报告
WHO流行病学调查第一阶段技术报告

The industrialization process of women of childbearing age youth occupational environment on reproductive health effects in the epidemiology

Technical report of first stage

1) Introduction

According to WHO’s prediction, in the 21 Century, infertility will be the second only to tumors and cardiovascular disease in the first three major diseases.The average incidence rate around the world is 7% ~ 46%. Despite differences in different regions, the present acceptable incidence in research field is 8% ~ 15%. In China, the incidence rate of infertility is relatively low before 1970s, but it begun to rise from early 1980s. Entering the 21st century, it shows clear ascendant trend, reaching as high as 8%-10% and even more than 15% in some regions.

The decline of reproductive capacity has become an important problem facing the rapid development of economic construction currently. It is proved by medical reports that infertility patients is increasing, and the number in urban areas is higher than that in rural areas. In highly-industrialized and densely-populated cities, the number of infertility is the highest. According to a large number of documents, the most influential acquired factor lies in the environment that we live by.The higher the region is industrialized, the higher the patients of infertility are. Environment, particularly the production environment, affects people's reproductive capacity. At present, over 100 chemicals

which mankind has a close contact with have been proved to have such effect. Nowadays, mankind activities, professional production activities in particular, can not continue without these chemical materials. These materials in human body, mainly plays an estrogenic effect (estrogen), directly affecting men and women's reproductive capacity.Other physical and chemical factors in workplaces effecting reproductive capacity should also be concerned now. But a comprehensive research on occupational factors is rare.

Occupational analysis shows that the exposed occupational environment is an important trigger of infertility. Nowadays, with our economy developing rapidly, traditional industry changing continually, and n ew industries emerging, new occupational hygienic problem is becoming salient. The incidence rate of infertility is increasing in China. Apart from the currently- known related factors, the other factors like whether the emerging occupational environment will pose threat to the reproductive capacity of human beings have not aroused people’s attention. People in the child-bearing age are the main labor resource, and the physical factors in many occupational environments will pose threat to people’s reproductive capacity in different degrees. The problem of the reproductive capacity exerts influence not only in healthy condition and the stability of a whole family, but also in the next generation, even in our nation’s great rejuvenation. We need economic

development as well as employment rate, but what we need desperately is the healthy life of our generation and our next generation. How can we avoid the influences on our reproductive capacity by occupational environments, and how can we evaluate the potential danger posed by these emerging occupational environments and the dangerous factors resulting in infertility as soon as possible. These questions should be the focus that needs our attention in today’s world, and there is a long way ahead. It is a meaningful and urgent work to pay much attention to reproductive health from the perspective of epidemiology.

2) Work in the first stage

(1)Complete bibliographic search, and consult 600 pieces of literature.

From December 2010, we hyperlinked CNKI, WanFang database, Sinomed, PUBMED etc. from library of Capital Medical University. More than 600 pieces of literature can be found by the key words such as “infertility”.

(2)Write a summary of these literature having 3000 letters.

We have summarized these literature, finishing a report called “A current situation of infertility”which has about 3000 letters. We in our report elaborated the occupation distribution of the infertility patients by doing a separate research between women and men, and also influence by the main occupation factors. In addition, we discussed initially the

reasons causing infertility and gave a simple analysis about these reasons.

(3) Finish a questionnaire. Appendix 1

Through a comprehensive summary about infertility, we have a further understanding about the research and have finalized important questions in our questionnaire.

A. The gender of the questioned person

B.The occupation of questioned people. As for the specific

occupational classifications, we adopt the 2010 sixth national

population census occupational classification standards.

Occupation can be classified into 3 categories, that are large,

medium and small. There are 8 large occupations, 65 medium,

and 410 small occupations. Our research is target at the 7th, 8th,

9th large occupation.

Instruction: (1) As for the personnel who at the same time is engaged in more than one occupation, the one spending longer working time is his or her occupation. If the time cannot be determined, the one earning more money is his or her occupation. As for the personnel who at the same time is engaged in more than one occupation at he same workplace, the one possessing a higher tech is his or her occupation. (2) As for apprentice, they should be classified according to their work types and study fields. (3) The personnel who is engaged in technical occupation

as well as in administration should be classified according to his administrative occupation. (4) The personnel who is engaged in communist party as well as in administration should be classified according to his main occupation.

C.Work kinds of the questioned person: according to the

description of work types, we have to research the work types of

questioned people as assistance. In our research form, we need a

detailed record of work nature, work time, and work types of

questioned people. As for researchers, we need our researchers to

analyze and research the occupation contacts of questioned

people.

D.Work nature of questioned people: sedentary or the opposite

E.Work time of questioned people: the working hours of day and

night and the total working days in one week

F.Work types: brain work, manual work, brain-based work, or

physical-based work.

G.The condition of marriage and fertility of the surveyed people.

According to the latest diagnostic criteria of infertility, the

couple who have normal sexual life without conceptive measures

cannot bear child should be counted as infertility. According to

the criteria, we can conclude the related resulted result from

some projects in our questionnaire.

H. Other projects in the questionnaire. Other projects are mainly for

physiology and reproductive heath of both men and women. As

an assisted project, the content bears no clear relation with our

investigation conclusion, but it can be used in our next stage to

analyze the potential causes leading to infertility.

(4) Finish the handbook of implementing projects

According the analysis of this research, the target of the research is the related exposed factors affecting infertility. We explore the danger posed by key occupational environments on reproductive capacity, particularly on infertility. We also do a research on the occupation distribution and potential influence of occupational environment of infertility patients. We set up a information platform which analyzes the influence of occupational environment on reproductive health. We can put forward some possible preventative measures.

Our handbook of implementing projects is very specific, because it includes the object of the research, research contents, methods, detailed procedures, and the administration and evaluation system of projects.

(5)Finish the handbook of researchers, and train dozens of researchers.

In the handbook of researchers, we target the labor forces working in newly-industrialized environment and other workers in related environment as our research object.

The research can be divided into the following steps.

Firstly, distribute the questionnaire into surveyed regions. The principle: under the principle of random sample, we position our surveyed people in pearl river delta and around Beijing area which posses many new industries.

Secondly, distribute the questionnaire into surveyed units. The principle: under the principle of random sample, we should select different factories and different occupational personnel in the same factory as our target.

Thirdly, distribute the questionnaires to the person under investigation. The operation principle: under the principle of random sampling, strictly selecting the samples under investigation through questionnaires: people who are married, and plan to have children, but do not use contraception.

Specific operation in the process of investigation:

(1) The preparation before filling the questionnaire

Before asking the respondent to fill the questionnaire, the investigator should first make clear his intention, and lay stress on the point that this investigation is conducted in an anonymous way. The

investigator should also make clear that the survey data are produced by the computer, and the privacy of the respondent can be strictly guaranteed, so that the respondent would not have worries. There is no right or wrong answers, the questionnaire only need the respondent to tell his or her real opinion. With the agreement of the respondent, the respondent tick the option of being fully formed by himself, and the investigator get the informed-consent agreement. Then the investigator needs to explain the relative issues and meaning of the options.

A. while filling the questionnaire, the respondent should fill the questionnaire carefully.

B. unless otherwise stated, the respondent should answer the required questions as much as possible.

C. When answering the choice questions, the provided choices may mot fully express the intention of the investigator. In this case, the question can have specific explanation.

D. Pay attention to the logical relation of successive questions.

(2) Operation after filling the questionnaire

After the respondent fills the questionnaire, the investigator should timely check each question whether it meets the relative requirement, and take the following measures correspondently.

A. complete the missing questions, especially the first part, about basic personal information.

B. Correct the answer when more than one options are chosen, make sure that the number of chosen option meets the requirement.

The investigator should express thanks to the respondent after completing the survey.

(3) post processing work in spot of investigation.

A. The investigator needs to number the collected questionnaires.

B. Each investigator hands over the collected questionnaires to the project leader.

6. The experts meeting was held, and manual book and questionnaire were assessed and revised.

The experts meeting of this subject was held on the January 11, 2011. Participants included bureau chief Zheng from The Occupational Disease Dispensary, Zhang Xing, chief of subject section, Li Jian, president of Beijing Obstetrics and Gynecology Hospital, Ma Le, director of urology department, Yang Chi, and You Yang.

Considering the sensibility of the questions related to infertility and the privacy of reproductive health of men and women, this expert meeting redressed some questions related to direction in the questionnaire, avoided some sensitive questions, and suggested to acquire the information and elements related to infertility though questionnaire of indirect questions. It also further emphasized the

experiment measures, and gave concrete instruction to the detailed issues during the investigating process.

7. Pre- experiment of the completion of the investigation

We conducted an research of epidemiology on the productive health and Fertility factors of the people of childbearing age in the factories and enterprises in Beijing, Shenzhen and Dongwan. Following is the preliminary investigation report:

During this research, we conducted a research on the productive health condition of 2235 workers in 8 enterprises, including 1289 males, which accounts for 57.67% of the total number; and 946 females, accounting for 44.30%. After being examined and assessed by the investigator, among the 2235 collected questionnaires, there are 990 valid questionnaires, accounting for 44.30%; and 1245 null questionnaires, accounting for 65.70%.

Among the 1245 null questionnaires, there are 733 questionnaires done by males, accounting for 58.88%; and 512 done by females, accounting for 41.12%. As to the reasons of null questionnaires, 330 respondents refused to be surveyed after reading the informed agreement in the questionnaire, accounting for 26.51% of all the null questionnaires. Other reasons, such as ?°illogical answer?±, ?°most questions missing?±, accounts for 74.49%. As to the distribution of reasons and genders, 25 men refused to be investigated, accounting for

2.01% of all the null questionnaires, while other reasons of null reasons are 708, accounting for 56.87%. 382 women refused to be investigated, accounting for 30.68%, while other reasons of null reasons are 130, accounting for 10.44%. The data above shows that among the null questionnaires, most women refused to take the investigation because of privacy, while the majority of the men were unwilling to give exact answer out of other reasons.

Among 990 valid questionnaires, there are 541 questionnaires of male, accounting for 54.65% of all the valid questionnaires. There are 449 valid questionnaires done by women, accounting for 45.35% of all the valid questionnaires.

Among the 541 valid questionnaires of men, 93 people’s wife had pregnant experience for 149 times after they had the current job. Men whose wife had pregnant experience account for 17.19%. 98 men’s wife had the experience of birth giving for 99 times, accounting for 18.30% of the valid questionnaires. There are 66 men whose wife had both the experience of pregnancy and birth giving, accounting for 12.12% of the valid questionnaires of men. Through these data it is can be ensured that 125 people do not have the problem of infertility, accounting for 23.11% of the valid questionnaires of men. 31 respondents are planning to have children, accounting for 5.95% of the valid questionnaires of men. There are 3 respondents who have had plan to have children for more than 12

months, without using contraception. According to the diagnostic criteria of infertility by WHO, these 3 respondents are considered to be infertile. The infertile males account for 2.34%, which account for 0.55% of all the valid questionnaires of men. Among the 3 male respondents that could be diagnosed as infertile, two are workers in telecommunication industry and pharmacy industry; the other one is a common company staff doing clerical work. Among these 3 respondents, there is one person whose wife had pregnant experience before he had the current job, and another one has children now. Therefore, these two respondents are considered to be Secondary infertility, and one to be primary infertility.

Among the 449 valid questionnaires of women, 104 respondents had been pregnant after they had current job, with the total number as 130 times. Female respondents who had pregnant experience account for 23.16%. 85 female respondents had birth giving experience after they had the current job, for 89 times. Female respondents who had birth giving experience account for 18.93% of all the valid questionnaires of women. 79 female respondents had both experience of pregnancy and birth giving after they had current job, accounting for 17.59% of the valid questionnaires of females. Through the data above, it can be sure that 110 female respondents are not infertile, accounting for 24.50% of the valid questionnaires of the females. 29 female respondents have birth

plan in short term, accounting for 6.46% of the valid questionnaires of female respondents. There are 8 female respondents who have had birth plan for 12 months, but without using contraception. According to the diagnostic criteria of WHO, these 8 female respondents can be diagnosed as infertile. Among the 8 female respondents that could be diagnosed as infertile, two are workers in telecommunication industry and pharmacy industry; the other one is a common company staff doing clerical work. Among these 3 respondents, there is one person who had pregnant experience before having the current job, and another one has children now. Therefore, these two respondents are considered to be secondary infertility, and one to be primary infertility.

3) Problems and correction methods discovered in the first stage:

1. From the previous trials, we have drew a conclusion that our survey. methods were correct,but the base number of people that we need to investigate was relatively large. The enormous access amount was our biggest difficulty. If we want to get 10,000 data volum, the overall number of people needed to be investigated will reach 300,000. There are many professions and projets to be investigated, so only large sample data will be convincing.

2.The enterprises to be investigated do not have intense labour force, nor do they have high requirements for majors or educational background. After investigation, it was found that the structure of

employees' common age in the enterprises were relatively young. Most of the employees were single or newly got married who did not plan to reproduce. Because the personnel mobility was so big, pure questionnarie may not be able to finish a sample size of 3000 people. Therefore, we considered to add methods of telephone interview, short message survey and web survey.

4)Conclusion and outlook

1. The prelimiliry estimated number of questionaires of this survey is 300000.

2. The successful completion of work in this stage is the good foundation for the work in the next stage. However, it is undeniable that questionnaire survey requires cooperation from all aspects, which is the greatest problem in this stage.

3. The environment of New Industry has large technology density, but small and dispersed population density. Moreover, with the continuously improvement of population quality, people have increased awareness of the importance of privacy protection. Therefore, the epidemiological survey is an effort and time consuming work, and required understanding and cooperation from all aspects. For this reason, we apply for more time in order to expand the number of samples.

4. For the work in the next stage, emphasis will be laid on the specific work of the questionnaire survey, the confirmation of high risk

profession and cooperation with relevant organization. We will further strengthen the supervision of the work, so that we can timely accomplish this survey with high quality.

Annex 1 Operational manual

Annex 2

科学技术发展报告

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参考文献 (7) 现代科学技术的发展趋势 摘要:当今时代,科技发展突飞猛进,极大的推动了社会的进步,改变了人类生活的面貌。尤其是第二次世界大战以来,科学技术的发展更是日新月异,不少学者称之为"第三次技术革命",以表明其划时代的意义或用"知识爆炸"来形容现代科技发展的高速度。随着科学技术的不断发展以及与人类社会的紧密结合,人们也开始思考关于科技发展的哲学命题:例如科学技术的本质问题、科技与自然的关系问题、科技与社会的关系问题、科技与人的自身关系问题等等。同时,科学技术本身也呈现出了超越以往时代的特点。

关键词:科学技术人类社会发展 1.20世纪科学技术的发展 20世纪是科学技术空前辉煌的世纪,人类创造了历史上最为巨大的科学成就和物质财富。这些成就深刻地改变了人类生产和生活的方式及质量,同时也深刻地改变了人类的思维观念和对世界的认识,改变并继续改变着世界的面貌,极大地推动了社会的发展。纵观20世纪中叶以来50多年间,科学技术发展大致经历了6次大变革。 表1 20世纪现代科技经历的6次变革 上表显示出了20世纪总体上世界科技发展的特点: 1.1科学技术成为支撑、引领经济社会发展的主导力量 量子理论促进了集成电路计算机的发展,奠定了信息产业的发展;相对论和原子核裂变原理形成了核技术和核能工业;分子生物学和遗传学成就发展了生物技术和生物产业。 1.2科学技术向应用转化速度不断加快,科技成果产业化周期大大缩短 19世纪贝尔发明电话,掀开了人类通讯史从此一个全新的篇章。但相比电

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当代科学技术发展的特点和趋势以及对未来的 影响 Document serial number【NL89WT-NY98YT-NC8CB-NNUUT-NUT108】

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