心内科住院患者肺部感染的病原菌分布及危险因素分析

目的探讨心内科住院患者肺部感染的病原菌分布及危险因素,为预防心内科住院患者肺部感染提供临床依据。方法分析医院心内科2010年6月-2012年6月1 308例住院患者肺部感染的发生率及病原学分布,调查患者的一般资料,分析心内科住院患者发生肺部感染的危险因素;采用SPSS 18.0软件进行统计分析,采用χ2检验和logistic回归模型进行危险因素的单因素分析和多因素分析。结果 1 308例患者共发生肺部感染137例,感染率为10.47%,其中上呼吸道感染61例占44.53%,下呼吸道感染76例占55.47%;共分离出病原菌137株,其中革兰阳性菌45株占32.85%;革兰阴性菌76株占55.47%;真菌16株占11.68%,排前3位的病原菌依次为金黄色葡萄球菌、铜绿假单胞菌和嗜麦芽寡养单胞菌,分别占16.06%、13.87%、11.68%;年龄、侵入性操作、机械通气、ICU停留、肺部感染史、卧床时间、血清白蛋白低及抗菌药物使用种类均为心内科住院患者肺部感染的高危因素(P<0.01)。结论心内科住院患者肺部感染的发生率较高,且下呼吸道感染的比例稍高,主要病原菌为革兰阴性菌、其次为革兰阳性菌,真菌较少;该类患者发生肺部感染的危险因素较多,应针对高危因素进行预防干预。     

脑外科269例下呼吸道感染病例调查分析与对策

目的探讨医院脑外科患者下呼吸道医院感染特点及病原菌分布。方法对医院2006年1月-2009年12月脑外科收治的3669例患者资料进行回顾性调查。结果 3669例患者中发生医院感染306例,360例次,例次感染率9.81%,其中下呼吸道感染269例次,占74.72%;病原菌检出174株,革兰阴性菌95株,占54.60%,革兰阳性菌47株,占27.01%,真菌32株,占18.39%;高危因素除年龄较大,住院时间长外,主要为手术、气管切开/插管、昏迷和留置胃管。结论脑外科患者下呼吸道感染率高、死亡率高,应针对相关危险因素,重点预防控制,以减少下呼吸道医院感染的发生。     

内分泌科住院患者医院感染的危险因素分析

目的分析内分泌科患者住院感染的相关危险因素及临床特点,以期对内分泌科患者住院感染的预防及治疗提供帮助。方法回顾性分析2013年9月-2015年4月内分泌科住院患者989例,以期找到其相关危险因素及临床特点。结果内分泌科989例患者中发生医院感染71例,感染率为7.18%;患者年龄、糖尿病及住院时间等因素与感染的发生有密切关系,患有糖尿病的患者具有较高的医院感染发生率,另外,医院卫生环境,日常规章制度也对感染率有一定的影响;65株病原菌中革兰阴性杆菌44株,占67.69%;革兰阳性球菌21株,占32.31%,革兰阴性菌包括大肠埃希菌占32.31%、变形菌占20.00%、克雷伯菌占15.38%,革兰阳性菌以肠球菌占23.08%和表皮葡萄球菌占9.23%;71例感染患者临床表现部位以呼吸道与泌尿道感染比重较高,分别占45.06%和40.85%。结论内分泌科医院感染发生率偏高;患者年龄、疾病性质及住院时间是影响内分泌科医院感染的主要危险因素;临床病原菌分布广泛,主要以大肠埃希菌、变形菌、克雷伯菌等革兰阴性菌为主;临床表现部位感染以呼吸道、泌尿道感染为主;为减少医院感染率,需积极采取有效的措施。     

开放性损伤出血患者感染的调查与预防

目的研究开放性损伤出血患者感染的病原菌分布及危险因素,以采取有效措施控制感染的发生。方法回顾性分析2011年1月-2012年12月诊治的968例开放性损伤出血患者临床资料,统计患者感染的病原菌分布及危险因素,数据采用SPSS 18.0软件进行统计处理。结果 968例开放性损伤出血患者发生感染116例,感染率为12.0%;共检出病原菌120株,其中革兰阳性菌43株占35.83%、革兰阴性菌72株占60.00%、真菌5株占4.17%;患者住院时间长、合并有其他疾病、导尿管留置时间长、进行侵入性操作、应用呼吸机以及为预防性应用抗菌药物等是开放性损伤出血感染的危险因素。结论开放性损伤出血患者感染的发生率高,临床医护工作人员应根据开放性损伤出血患者感染的危险因素,采取相应的预防治疗措施控制医院出血患者感染的发生。     

急性白血病医院感染危险因素及防治对策

目的探讨急性白血病发生医院感染的危险因素以及采取的相对应防治对策,以期为其预防与控制医院感染提供可靠依据。方法采用回顾性与前瞻性研究方法对2007年6月-2013年6月医院治疗的108例初发急性白血病患者临床资料进行分析,分析其发生医院感染情况及危险因素。结果 108例急性白血病患者发生医院感染92例、94例次,医院感染率85.19%、例次感染率87.04%;感染部位以上呼吸道、下呼吸道、血液为主,分别占41.49%、19.15%、11.70%;共分离出病原菌94株,其中革兰阴性菌54株占57.45%,革兰阳性菌28株占29.79%,真菌12株占12.76%;年龄、住院时间、化疗持续时间、白细胞计数、粒细胞计数和抗菌药物预防性应用等因素是导致急性白血病患者发生医院感染的主要危险因素(P<0.05)。结论急性白血病患者医院感染率高,临床上应当针对患者年龄、住院时间、化疗持续时间、白细胞计数、粒细胞计数和抗菌药物预防性应用等相关危险因素采取积极的防治对策,减少医院感染的发生,以提高患者治疗水平,延长患者生存期。     

消化内科医院感染病原菌分析与预防

目的探讨消化内科医院感染危险因素、病原菌特点及预防策略,为降低医院感染率提供参考。方法回顾性分析2013年5月-2015年7月医院消化内科收治的700例住院患者临床资料,记录医院感染率及病原菌构成;收集患者临床资料,分析导致医院感染的危险因素;采用SPSS16.0软件对数据进行统计分析。结果 700例住院患者发生医院感染25例,感染率3.6%;感染部位以消化道、上呼吸道和泌尿生殖系统为主,分别占28.0%、20.0%和20.0%;共分离出病原菌52株,其中革兰阴性菌34株占65.4%,革兰阳性菌13株占25.0%,真菌5株占9.6%;年龄65岁、胃癌或食管癌等恶肿瘤患者、住院时间7d、合并糖尿病、伴有侵入性操作、每日探视3人、病程2周的患者医院感染率显著上升(P0.05);多因素分析显示,原发病、住院时间、合并糖尿病、伴有侵入性操作是消化内科住院患者发生医院感染的独立危险因素。结论原发病、住院时间、合并糖尿病、伴有侵入性操作,是消化内科住院患者发生医院感染的危险因素;临床上需要针对相关危险因素制定对应的预防策略,从而降低医院感染率。     

产科住院产妇医院感染诱发因素研究

目的探讨产科住院产妇医院感染特点及相关因素,为医院感染预防控制提供理论依据。方法回顾性分析2010年1月-2014年12月医院产科收治的12 191例住院产妇临床资料,统计分析医院感染的危险因素;采用SPSS19.0软件对数据进行统计分析。结果 2010年1月-2014年12月12 191例产妇共发生医院感染302例,感染率为2.5%;感染部位以切口和呼吸道感染为主,分别占47.3%和37.1%;302例感染产妇共检出病原菌135株,检出率44.7%,其中革兰阴性菌80株占59.3%,革兰阳性45株占33.3%,厌氧菌10株占7.4%;产后出血、贫血、妊娠期高血压疾病、妊娠期糖尿病、胎膜早破、宫腔操作、缝合技术、产程延长是产科住院产妇发生医院感染的独立危险因素(P0.05)。结论产科病房应加强条件致病菌的检测,针对易感人群做好预防工作,降低医院感染。     

新生儿ICU医院感染调查分析

目的探讨新生儿医院感染的高危因素,分析常见医院感染病原菌特点,为预防和控制医院感染提供临床依据。方法回顾性分析2010年1月-2013年9月住院新生儿的临床资料,按是否感染将新生儿分为感染组与非感染组,调查分析医院感染高危因素,对细菌学检测结果进行分析,分析其抗菌药物敏感性及耐药性。结果 3 583例住院新生儿中,发生医院感染者154例,感染率为4.3%;胎龄≤32周、宫内感染、机械通气、胎膜早破、住院时间延长等是新生儿医院感染的危险因素(P<0.05);共检出病原菌73株,其中革兰阴性菌58株占79.5%,革兰阳性菌15株占20.5%;主要革兰阴性菌对氨苄西林的耐药率较高,>83.3%,对亚胺培南、哌拉西林/他唑巴坦、头孢他啶、头孢吡肟较敏感,耐药率<27.3%。结论应定期评估医院感染的高危因素,并进行及时干预;革兰阴性菌为医院感染主要病原菌,应合理选择敏感抗菌药物,降低医院感染率。     

脊柱术后医院感染病原菌特征与危险因素分析

目的探讨脊柱术后医院感染病原菌特征及相关危险因素,为临床预防与治疗提供参考。方法回顾性分析2008年10月-2013年10月在医院行脊柱外科手术的497例患者临床资料,记录感染部位、病原菌分布及其耐药性,并分析引起医院感染的高危因素。结果 497例脊柱手术患者中发生医院感染25例,感染率5.03%,感染部位以上呼吸道、泌尿道、切口感染为主;25例医院感染患者共分离出41株病原菌,其中革兰阴性菌22株占53.7%,革兰阳性菌15株占36.6%,真菌4株占9.7%;铜绿假单胞菌对亚胺培南、美罗培南的耐药率较低,革兰阳性菌对万古霉素耐药率较低;多因素分析显示,手术时间、合并基础疾病是医院感染独立危险因素,术前抗菌药物预防是医院感染保护因素。结论脊柱术后患者医院感染病原菌以革兰阴性菌为主,手术时间、合并基础疾病是医院感染独立危险因素,术前抗菌药物预防是医院感染保护因素。     

产科患者发生医院感染影响因素分析与防范对策研究

目的探讨产科患者医院感染影响因素,以此提出相关防范对策,为促进产妇康复提供保障。方法回顾性分析医院2014年1月-2016年6月产科5 550例住院产妇临床资料,对发生院内感染患者的相关危险因素进行调查与分析,同时对有意义单因素行logistic回归多因素分析,并根据调查结果实施相关预防对策。结果 5 550例产科住院产妇中,其中医院感染者55例,感染率为0.99%;感染部位以上呼吸道感染为主,共20例占36.36%;共分离出病原菌84株,以革兰阴性菌为主,共37株占44.05%;logistic回归多因素分析结果显示,产后出血、贫血、妊娠并发症、产程延长、缝合技术、侵入操作、分娩方式、住院时间、阴道检查次数、每日探视人数为产科发生医院感染的独立危险因素(P<0.05)。结论产科医院感染影响因素较多,以革兰阴性菌为主,因此临床需掌握患者院内感染特点及病原菌情况,加强对相关因素的干预,积极选取合理抗菌药物治疗,为促进患者康复提供保障。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.