WHO流行病學調查第一階段技術報告

Theindustrializationprocessofwomenofchildbearing

ageyouthoccupationalenvironmentonreproductive

gy

Technicalreportoffirststage

Introduction

AccordingtoWHO'prediction,inthe21Century,infertilitywillbethesecondonlytotumorsandcardiovasculardiseaseinthefirstthreemajordiseases.Theaverageincidenceratearoundtheworldis7%?46%.Despitedifferencesindifferentregions,thepresentacceptableincidenceinresearchfieldis8%?15%.InChina,theincidencerateofinfertilityisrelativelylowbefore1970s,butitbeguntorisefromearly1980s.Enteringthe21stcentury,itshowsclearascendanttrend,reachingashighas8%-10%andevenmorethan15%insomeregions.

Thedeclineofreproductivecapacityhasbecomeanimportantproblemfacingtherapiddevelopmentofeconomicconstructioncurrently.Itisprovedbymedicalreportsthatinfertilitypatientsisincreasing,andthenumberinurbanareasishigherthanthatinruralareas.Inhighly-industrializedanddensely-populatedcities,thenumberofinfertilityisthehighest.Accordingtoalargenumberofdocuments,themostinfluentialacquiredfactorliesintheenvironmentthatweliveby.Thehighertheregionisindustrialized,thehigherthepatientsofinfertilityare.Environment,particularlytheproductionenvironment,affectspeople'sreproductivecapacity.Atpresent,over100chemicals

whichmankindhasaclosecontactwithhavebeenprovedtohavesucheffect.Nowadays,mankindactivities,professionalproductionactivitiesinparticular,cannotcontinuewithoutthesechemicalmaterials.Thesematerialsinhumanbody,mainlyplaysanestrogeniceffect(estrogen),directlyaffectingmenandwomen'sreproductivecapacity.Otherphysicalandchemicalfactorsinworkplaceseffectingreproductivecapacityshouldalsobeconcernednow.Butacomprehensiveresearchonoccupationalfactorsisrare.

Occupationalanalysisshowsthattheexposedoccupationalenvironmentisanimportanttriggerofinfertility.Nowadays,withoureconomydevelopingrapidly,traditionalindustrychangingcontinually,andnewindustriesemerging,newoccupationalhygienicproblemisbecomingsalient.TheincidencerateofinfertilityisincreasinginChina.Apartfromthecurrently-knownrelatedfactors,theotherfactorslikewhethertheemergingoccupationalenvironmentwillposethreattothereproductivecapacityofhumanbeingshavenotarousedpeople'sattention.Peopleinthechild-bearingagearethemainlaborresource,andthephysicalfactorsinmanyoccupationalenvironmentswillposethreattopeople'sreproductivecapacityindifferentdegrees.Theproblemofthereproductivecapacityexertsinfluencenotonlyinhealthyconditionandthestabilityofawholefamily,butalsointhenextgeneration,eveninournation'sgreatrejuvenation.Weneedeconomic

developmentaswellasemploymentrate,butwhatweneeddesperatelyisthehealthylifeofourgenerationandournextgeneration.Howcanweavoidtheinfluencesonourreproductivecapacitybyoccupationalenvironments,andhowcanweevaluatethepotentialdangerposedbytheseemergingoccupationalenvironmentsandthedangerousfactorsresultingininfertilityassoonaspossible.Thesequestionsshouldbethefocusthatneedsourattentionintoday'sworld,andthereisalongwayahead.Itisameaningfulandurgentworktopaymuchattentiontoreproductivehealthfromtheperspectiveofepidemiology.

Workinthefirststage

Completebibliographicsearch,andconsult600piecesofliterature.

FromDecember2010,wehyperlinkedCNKI,WanFangdatabase,Sinomed,PUBMEDetc.fromlibraryofCapitalMedicalUniversity.Morethan600piecesofliteraturecanbefoundbythekeywordssuchas“infertility”.

Writeasummaryoftheseliteraturehaving3000letters.

Wehavesummarizedtheseliterature,finishingareportcalled“Acurrentsituationofinfertility”whichhasabout3000letters.Weinourreportelaboratedtheoccupationdistributionoftheinfertilitypatientsbydoingaseparateresearchbetweenwomenandmen,andalsoinfluencebythemainoccupationfactors.Inaddition,wediscussedinitiallythe

reasonscausinginfertilityandgaveasimpleanalysisaboutthesereasons.

Finishaquestionnaire.Appendix1

Throughacomprehensivesummaryaboutinfertility,wehaveafurtherunderstandingabouttheresearchandhavefinalizedimportantquestionsinourquestionnaire.

Thegenderofthequestionedperson

Theoccupationofquestionedpeople.Asforthespecificoccupationalclassifications,weadoptthe2010sixthnationalpopulationcensusoccupationalclassificationstandards.Occupationcanbeclassifiedinto3categories,thatarelarge,mediumandsmall.Thereare8largeoccupations,65medium,and410smalloccupations.Ourresearchistargetatthe7th,8th,9thlargeoccupation.

Instruction:(1)Asforthepersonnelwhoatthesametimeisengagedinmorethanoneoccupation,theonespendinglongerworkingtimeishisorheroccupation.Ifthetimecannotbedetermined,theoneearningmoremoneyishisorheroccupation.Asforthepersonnelwhoatthesametimeisengagedinmorethanoneoccupationathesameworkplace,theonepossessingahighertechishisorheroccupation.(2)Asforapprentice,theyshouldbeclassifiedaccordingtotheirworktypesandstudyfields.(3)Thepersonnelwhoisengagedintechnicaloccupation

aswellasinadministrationshouldbeclassifiedaccordingtohisadministrativeoccupation.(4)Thepersonnelwhoisengagedincommunistpartyaswellasinadministrationshouldbeclassifiedaccordingtohismainoccupation.

Workkindsofthequestionedperson:accordingtothedescriptionofworktypes,wehavetoresearchtheworktypesofquestionedpeopleasassistance.Inourresearchform,weneedadetailedrecordofworknature,worktime,andworktypesofquestionedpeople.Asforresearchers,weneedourresearcherstoanalyzeandresearchtheoccupationcontactsofquestionedpeople.

Worknatureofquestionedpeople:sedentaryortheopposite

Worktimeofquestionedpeople:theworkinghoursofdayandnightandthetotalworkingdaysinoneweek

Worktypes:brainwork,manualwork,brain-basedwork,orphysical-basedwork.

Theconditionofmarriageandfertilityofthesurveyedpeople.Accordingtothelatestdiagnosticcriteriaofinfertility,thecouplewhohavenormalsexuallifewithoutconceptivemeasurescannotbearchildshouldbecountedasinfertility.Accordingtothecriteria,wecanconcludetherelatedresultedresultfromsomeprojectsinourquestionnaire.

Otherprojectsinthequestionnaire.Otherprojectsaremainlyforphysiologyandreproductiveheathofbothmenandwomen.Asanassistedproject,thecontentbearsnoclearrelationwithourinvestigationconclusion,butitcanbeusedinournextstagetoanalyzethepotentialcausesleadingtoinfertility.

Finishthehandbookofimplementingprojects

Accordingtheanalysisofthisresearch,thetargetoftheresearchistherelatedexposedfactorsaffectinginfertility.Weexplorethedangerposedbykeyoccupationalenvironmentsonreproductivecapacity,particularlyoninfertility.Wealsodoaresearchontheoccupationdistributionandpotentialinfluenceofoccupationalenvironmentofinfertilitypatients.Wesetupainformationplatformwhichanalyzestheinfluenceofoccupationalenvironmentonreproductivehealth.Wecanputforwardsomepossiblepreventativemeasures.

Ourhandbookofimplementingprojectsisveryspecific,becauseitincludestheobjectoftheresearch,researchcontents,methods,detailedprocedures,andtheadministrationandevaluationsystemofprojects.

Finishthehandbookofresearchers,andtraindozensofresearchers.

Inthehandbookofresearchers,wetargetthelaborforcesworkinginnewly-industrializedenvironmentandotherworkersinrelatedenvironmentasourresearchobject.

Theresearchcanbedividedintothefollowingsteps.

Firstly,distributethequestionnaireintosurveyedregions.Theprinciple:undertheprincipleofrandomsample,wepositionoursurveyedpeopleinpearlriverdeltaandaroundBeijingareawhichpossesmanynewindustries.

Secondly,distributethequestionnaireintosurveyedunits.Theprinciple:undertheprincipleofrandomsample,weshouldselectdifferentfactoriesanddifferentoccupationalpersonnelinthesamefactoryasourtarget.

Thirdly,distributethequestionnairestothepersonunderinvestigation.Theoperationprinciple:undertheprincipleofrandomsampling,strictlyselectingthesamplesunderinvestigationthroughquestionnaires:peoplewhoaremarried,andplantohavechildren,butdonotusecontraception.

Specificoperationintheprocessofinvestigation:

Thepreparationbeforefillingthequestionnaire

Beforeaskingtherespondenttofillthequestionnaire,theinvestigatorshouldfirstmakeclearhisintention,andlaystressonthepointthatthisinvestigationisconductedinananonymousway.The

investigatorshouldalsomakeclearthatthesurveydataareproducedbythecomputer,andtheprivacyoftherespondentcanbestrictlyguaranteed,sothattherespondentwouldnothaveworries.Thereisnorightorwronganswers,thequestionnaireonlyneedtherespondenttotellhisorherrealopinion.Withtheagreementoftherespondent,therespondentticktheoptionofbeingfullyformedbyhimself,andtheinvestigatorgettheinformed-consentagreement.Thentheinvestigatorneedstoexplaintherelativeissuesandmeaningoftheoptions.

whilefillingthequestionnaire,therespondentshouldfillthequestionnairecarefully.

unlessotherwisestated,therespondentshouldanswertherequiredquestionsasmuchaspossible.

Whenansweringthechoicequestions,theprovidedchoicesmaymotfullyexpresstheintentionoftheinvestigator.Inthiscase,thequestioncanhavespecificexplanation.

Payattentiontothelogicalrelationofsuccessivequestions.

Operationafterfillingthequestionnaire

Aftertherespondentfillsthequestionnaire,theinvestigatorshouldtimelycheckeachquestionwhetheritmeetstherelativerequirement,andtakethefollowingmeasurescorrespondently.

A.completethemissingquestions,especiallythefirstpart,aboutbasicpersonalinformation.

B.Correcttheanswerwhenmorethanoneoptionsarechosen,makesurethatthenumberofchosenoptionmeetstherequirement.

Theinvestigatorshouldexpressthankstotherespondentaftercompletingthesurvey.

postprocessingworkinspotofinvestigation.

Theinvestigatorneedstonumberthecollectedquestionnaires.

Eachinvestigatorhandsoverthecollectedquestionnairestotheprojectleader.

Theexpertsmeetingwasheld,andmanualbookandquestionnairewereassessedandrevised.

TheexpertsmeetingofthissubjectwasheldontheJanuary11,2011.ParticipantsincludedbureauchiefZhengfromTheOccupationalDiseaseDispensary,ZhangXing,chiefofsubjectsection,LiJian,presidentofBeijingObstetricsandGynecologyHospital,MaLe,directorofurologydepartment,YangChi,andYouYang.

Consideringthesensibilityofthequestionsrelatedtoinfertilityandtheprivacyofreproductivehealthofmenandwomen,thisexpertmeetingredressedsomequestionsrelatedtodirectioninthequestionnaire,avoidedsomesensitivequestions,andsuggestedtoacquiretheinformationandelementsrelatedtoinfertilitythoughquestionnaireofindirectquestions.Italsofurtheremphasizedthe

experimentmeasures,andgaveconcreteinstructiontothedetailedissuesduringtheinvestigatingprocess.

Pre-experimentofthecompletionoftheinvestigation

WeconductedanresearchofepidemiologyontheproductivehealthandFertilityfactorsofthepeopleofchildbearingageinthefactoriesandenterprisesinBeijing,ShenzhenandDongwan.Followingisthepreliminaryinvestigationreport:

Duringthisresearch,weconductedaresearchontheproductivehealthconditionof2235workersin8enterprises,including1289males,whichaccountsfor57.67%ofthetotalnumber;and946females,accountingfor44.30%.Afterbeingexaminedandassessedbytheinvestigator,amongthe2235collectedquestionnaires,thereare990validquestionnaires,accountingfor44.30%;and1245nullquestionnaires,accountingfor65.70%.

Amongthe1245nullquestionnaires,thereare733questionnairesdonebymales,accountingfor58.88%;and512donebyfemales,accountingfor41.12%.Astothereasonsofnullquestionnaires,330respondentsrefusedtobesurveyedafterreadingtheinformedagreementinthequestionnaire,accountingfor26.51%ofallthenullquestionnaires.Otherreasons,suchasj°illogicalanswerj土，j°mostquestionsmissingj土，accountsfor74.49%.Astothedistributionofreasonsandgenders,25menrefusedtobeinvestigated,accountingfor

2.01%ofallthenullquestionnaires,whileotherreasonsofnullreasonsare708,accountingfor56.87%.382womenrefusedtobeinvestigated,accountingfor30.68%,whileotherreasonsofnullreasonsare130,accountingfor10.44%.Thedataaboveshowsthatamongthenullquestionnaires,mostwomenrefusedtotaketheinvestigationbecauseofprivacy,whilethemajorityofthemenwereunwillingtogiveexactansweroutofotherreasons.

Among990validquestionnaires,thereare541questionnairesofmale,accountingfor54.65%ofallthevalidquestionnaires.Thereare449validquestionnairesdonebywomen,accountingfor45.35%ofallthevalidquestionnaires.

Amongthe541validquestionnairesofmen,93people'swifehadpregnantexperiencefor149timesaftertheyhadthecurrentjob.Menwhosewifehadpregnantexperienceaccountfor17.19%.98men'swifehadtheexperienceofbirthgivingfor99times,accountingfor18.30%ofthevalidquestionnaires.Thereare66menwhosewifehadboththeexperienceofpregnancyandbirthgiving,accountingfor12.12%ofthevalidquestionnairesofmen.Throughthesedataitiscanbeensuredthat125peopledonothavetheproblemofinfertility,accountingfor23.11%ofthevalidquestionnairesofmen.31respondentsareplanningtohavechildren,accountingfor5.95%ofthevalidquestionnairesofmen.Thereare3respondentswhohavehadplantohavechildrenformorethan12

months,withoutusingcontraception.AccordingtothediagnosticcriteriaofinfertilitybyWHO,these3respondentsareconsideredtobeinfertile.Theinfertilemalesaccountfor2.34%,whichaccountfor0.55%ofallthevalidquestionnairesofmen.Amongthe3malerespondentsthatcouldbediagnosedasinfertile,twoareworkersintelecommunicationindustryandpharmacyindustry;theotheroneisacommoncompanystaffdoingclericalwork.Amongthese3respondents,thereisonepersonwhosewifehadpregnantexperiencebeforehehadthecurrentjob,andanotheronehaschildrennow.Therefore,thesetworespondentsareconsideredtobeSecondaryinfertility,andonetobeprimaryinfertility.

Amongthe449validquestionnairesofwomen,104respondentshadbeenpregnantaftertheyhadcurrentjob,withthetotalnumberas130times.Femalerespondentswhohadpregnantexperienceaccountfor23.16%.85femalerespondentshadbirthgivingexperienceaftertheyhadthecurrentjob,for89times.Femalerespondentswhohadbirthgivingexperienceaccountfor18.93%ofallthevalidquestionnairesofwomen.79femalerespondentshadbothexperienceofpregnancyandbirthgivingaftertheyhadcurrentjob,accountingfor17.59%ofthevalidquestionnairesoffemales.Throughthedataabove,itcanbesurethat110femalerespondentsarenotinfertile,accountingfor24.50%ofthevalidquestionnairesofthefemales.29femalerespondentshavebirth

planinshortterm,accountingfor6.46%ofthevalidquestionnairesoffemalerespondents.Thereare8femalerespondentswhohavehadbirthplanfor12months,butwithoutusingcontraception.AccordingtothediagnosticcriteriaofWHO,these8femalerespondentscanbediagnosedasinfertile.Amongthe8femalerespondentsthatcouldbediagnosedasinfertile,twoareworkersintelecommunicationindustryandpharmacyindustry;theotheroneisacommoncompanystaffdoingclericalwork.Amongthese3respondents,thereisonepersonwhohadpregnantexperiencebeforehavingthecurrentjob,andanotheronehaschildrennow.Therefore,thesetworespondentsareconsideredtobesecondaryinfertility,andonetobeprimaryinfertility.

Problemsandcorrectionmethodsdiscoveredinthefirststage:

Fromtheprevioustrials,wehavedrewaconclusionthatoursurvey.methodswerecorrect,butthebasenumberofpeoplethatweneedtoinvestigatewasrelativelylarge.Theenormousaccessamountwasourbiggestdifficulty.Ifwewanttoget10,000datavolum,