主观综合性评估乙型肝炎性肝硬化病人的营养状况

目的:探讨主观综合性营养评估(SGA)在乙型肝炎性肝硬化病人中的应用价值. 方法:回顾分析乙型肝炎性肝硬化病人140例,根据Child-Pugh分级,将病人分为A、B和C组,比较各组间营养指标的差异,并分析Child-Pugh分级与营养指标的相关性. 结果:乙型肝炎性肝硬化病人营养不良的总发生率为42.85％,其中轻-中度营养不良40例(28.57％),重度营养不良20例(14.29％).各组间的体重指数(BMI)、肱三头肌皮皱厚度(TSF)、上臂围(AC)、上臂肌围(AMC)、肌酐身高指数(CHI)、血清转铁蛋白(TF)和清蛋白(ALB)等差异均有显著性统计学意义(P＜0.05).BMI和血清TF与病人Child-Pugh分级相关性不显著(P＞0.05),而AMC、TSF、CHI和血清ALB与病人Child-Pugh分级均呈负相关(r分别为-0.404、-0.673、-0.597、-0.814,P＜0.05). 结论:肝硬化病人多存在不同程度的营养不良,SGA可用于肝硬化病人营养状况的评估.     

综合性营养评估法在维持性血液透析患者中的应用

目的 对血液透析患者的几项营养指标进行评估.方法 对142例维持性血液透析(MHD)患者进行主观综合性营养评估(SGA)、膳食调查、生化参数的测定.结果 依据SGA评分,在营养良好、轻中度营养不良及重度营养不良三组间进行以下指标比较:平均每日每公斤体重能量(DEI)和蛋白质摄入(DPI)、血白蛋白(ALb),均有显著性差异(P＜0.001～0.05).但营养良好组的DEI和DPI异常率高达46.0%、49.0%,重度营养不良组中各指标异常率均在80%以上.血前白蛋白(PA)与血ALb有显著相关(P＜0.01),与DPI、DEI均无相关.结论 SGA是评价MHD患者营养状况的简便方法,但还需其它反映营养状况不同侧面指标的补充,如DEI、DPI、血ALb、血PA.     

酒精性肝硬化和病毒性肝硬化病人营养状况调查和分析

目的:对比分析酒精性肝硬化和病毒性肝硬化病人的营养状况,为营养支持提供针对性依据。方法:选择酒精性肝硬化病人95例,病毒性肝硬化病人260例,入院后48 h内采用欧洲营养风险筛查2002(NRS2002)和主观整体评估(SGA)法对病人进行评估,记录病人的性别、年龄、肝功能Child-Pugh分级、血清清蛋白(ALB)、前清蛋白(PA)和血红蛋白(Hb)指标,测量病人身高、体重,计算体重指数(BMI)。结果:酒精性肝硬化和病毒性肝硬化病人的NRS 2002营养风险发生率分别为76.80%和65.00%,SGA评估的营养不良发生率分别为67.40%和61.90%。两组病人的性别、Child-Pugh A级、ALB、PA、Hb、NRS 2002筛查等结果差异均有显著性统计学意义。而年龄、Child-Pugh B级、Child-Pugh C级、BMI、SGA评估等结果则无显著性差异。结论:两种类型肝硬化病人普遍存在营养问题,酒精性肝硬化病人的营养风险发生率、贫血程度显著高于病毒性肝硬化病人。     

腹膜透析患者营养指标的评估

目的 :　对腹膜透析患者的一些营养指标进行评估。方法 :　对 90例持续性不卧床腹膜透析 ( CAPD腹透 )患者进行主观综合性营养评估 ( SGA)、膳食调查、直接人体测量、生化参数的测定 ,计算氮出现率相当蛋白 ( n PNA)、瘦体重和 %瘦体重。结果 :　依据 SGA评分 ,在营养良好、轻中度营养不良及重度营养不良三组间进行以下指标比较 :平均每日每公斤体重能量和蛋白质摄入 ( DEI、DPI)、血白蛋白、n PNA、瘦体重及 %瘦体重 ,均有显著性差异 ( P<0 .0 0 1～ 0 .0 5 )。但营养良好组的 DPI和 DEI异常率 70 .2 1 % ,血白蛋白和 %瘦体重异常率 31 .91 %和 5 1 .0 6% ,而轻中度营养不良组血白蛋白和 %瘦体重正常率为 49.39%和 67.74% ,仅重度营养不良组中各指标异常率均在 80 %以上。直接人体测量指标体重指数、三头肌皮褶厚度和上臂肌围在本组患者中的异常率为 4.44% ,6.67%及 1 3.33%。血前白蛋白、转铁蛋白与白蛋白有显著相关 ( P<0 .0 0 1 ) ,与 DPI、DEI、n PNA及 %瘦体重均无相关。结论 :　SGA是评价腹透患者营养状况的简便方法 ,但还需其它反映营养状况不同侧面的指标的补充 ,如 DEI、DPI、血白蛋白、n PNA、瘦体重及 %瘦体重。其中用肌酐动力学公式计算瘦体重是反映肌肉蛋白质贮存的有效方法。直接人体测?     

慢性病毒性肝炎肝硬化合并慢性肾脏病病人的营养状况分析

目的:分析慢性病毒性肝炎肝硬化与慢性病毒性肝炎肝硬化合并慢性肾脏病(CKD)病人的营养状况。方法:选择慢性病毒性肝炎肝硬化病人105例,按是否合并CKD分为肝硬化组和肝硬化合并CKD组,记录入院时病人的性别、年龄、肝病病程、肾病基础疾病、肝功能Child-Pugh分级、血清白蛋白(ALB)、前白蛋白(PA)、血红蛋白(Hb)、淋巴细胞(L)绝对值、肾功能指标,体重指数(BMI)、三头肌皮褶厚度(TSF)、握力、欧洲营养风险筛查2002(NRS 2002)和主观整体评估(SGA)法对病人进行营养筛查与评估。结果:肝硬化组与肝硬化合并CKD组化验指标ALB、HB明显低于正常,两组间比较具有统计学意义;应用BMI、握力、TSF测量评价病人营养状况时,肝硬化组与肝硬化合并CKD组之间无统计学意义。肝硬化组与肝硬化合并CKD组应用NRS 2002营养风险发生率分别为32.81%和65.85%,两组间比较有统计学意义,尤其在Child-Pugh B级和C级病人;SGA评估营养不良发生率分别为28.12%和58.54%,两组间比较有统计学意义,但只在Child-Pugh B级病人有显著性差异。结论:合并CKD的肝硬化病人,营养风险发生率升高,随着肝硬化疾病的进展,营养风险及营养不良发生率进一步升高。     

外科肝癌患者营养状况与肝功能分级和临床结局的相关性分析

目的评估外科肝癌患者营养状况及其与肝功能分级和临床结局的相关性。方法2011年10月至2013年10月新入院接受手术治疗的肝硬化肝癌患者112例,采用肌酐-身高指数（CHI）、上臂围、握力和蛋白代谢指标等方法,以及患者主观整体评估（PG—SGA）分别进行营养状况评估;采用Child—Pugh分级评价肝脏功能,统计术后感染并发症和术后住院日作为临床结局指标。分析营养状况与肝脏功能、临床结局的相关性。结果根据PG—SGA分级,112例患者中70例（62．5％）营养正常,34例（30．4％）有中度营养不良,8例（7．1％）重度营养不良。以PG-SGA结果为标准,CHI法（K=0．760,P=0．000）、上臂围法（K=0．564,P=0．000）及握力（K=0．523,P=0．000）均与PG．SGA一致,其中CHI法与PD—SGA法吻合程度最强。肝功能Child—Pugh分级与PG—SGA分级之间呈显著正相关（rs=0．829,P=0．000）,PG—SGA分级与感染并发症及术后住院日均呈显著正相关（r=0．349,P=0．000;r=0．624,P=0．000）。结论PD—SGA结合CHI可较为准确地评估外科肝癌患者营养状况。患者的营养状况与肝脏功能分级、感染并发症发生率和术后住院日呈正相关。     

维持性血液透析病人的营养状况评价

目的:应用主观全面评定法(SGA)对维持性血液透析(MHD)病人的营养状况进行评价.方法:采用SGA结合有关生化指标,人体测量指标和饮食评估,对127例MHD病人的营养状况进行综合评价.结果:127例病人中营养良好者75例,轻中度营养不良39例,重度营养不良13例,总营养不良发生率为40.9%.各营养状况组之间血清ALB、PA、肌酐、肱三头肌皮皱厚度、饮食蛋白摄入量和蛋白质分解率差异显著,而三组间Kt/V无显著差异.结论:血液透析病人营养不良的发生率较高,与蛋白质摄入不足、炎症、血液透析过程本身等因素有关.     

综合性营养评估法在维持性血液透析患者中的应用

目的对血液透析患者的几项营养指标进行评估。方法对142例维持性血液透析（MHD）患者进行主观综合性营养评估（SGA）、膳食调查、生化参数的测定。结果依据SGA评分,在营养良好、轻中度营养不良及重度营养不良三组间进行以下指标比较：平均每日每公斤体重能量（DEI）和蛋白质摄入（DPI）、血白蛋白（ALb）,均有显著性差异（P〈0.001～0.05）。但营养良好组的DEI和DPI异常率高达46.0%、49.0%,重度营养不良组中各指标异常率均在80%以上。血前白蛋白（PA）与血ALb有显著相关（P〈0.01）,与DPI、DEI均无相关。结论SGA是评价MHD患者营养状况的简便方法,但还需其它反映营养状况不同侧面指标的补充,如DEI、DPI、血ALb、血PA。     

542例慢性呼吸系统疾病住院病人营养状况调查分析

目的:对慢性呼吸系统疾病病人进行营养风险筛查与评估,分析相关的营养不良危险因素,及早预测和发现营养不良的发生。方法:采用横断面调查法,对内蒙古自治区人民医院呼吸与危重症医学科新入院病人进行营养风险筛查与评估,应用营养风险筛查2002(NRS 2002)、SGA评分表、膳食调查自评表等进行营养状况评价、并收集入院时实验室检查结果,纳入年龄、吸烟史及受教育程度等因素进行统计分析。结果:全年新入院病人2 022例,排除不符合标准后纳入542例。根据SGA评分分组,性别、吸烟、年龄及膳食评分均与病人营养不良相关,差异具有统计学(P <0.05)。对比不同疾病病人的营养状况,发现肺癌病人重度营养不良病人比例高于其他慢性呼吸系统疾病病人,支气管扩张病人营养良好比例较高(P <0.05)。慢阻肺及肺癌病人白蛋白、前白蛋白水平低于其他慢性呼吸系统疾病病人、而C反应蛋白水平高于其他慢性呼吸系统疾病病人,支气管扩张病人血红蛋白低于其他慢性呼吸系统疾病病人,差异均有统计学意义(P <0.05)。结论:慢性呼吸系统疾病病人营养风险和营养不良发生率较高,尤其是慢阻肺病人,应足够重视早期筛查与评价。     

糖尿病肾病病人营养状况及其与血清胱抑素C水平的相关性分析

目的:评估糖尿病肾病(DN)病人的营养状况,探讨其与血清胱抑素C(CysC)水平的相关性. 方法:调查DN的住院病人73例,采用膳食调查、体格检查、实验室检查、主观全面性营养评估(SGA)法综合评价病人的营养状况,根据营养评价结果分为营养良好组(A组),轻-中度营养不良组(B组)和重度营养不良组(C组),所得数据经软件统计分析各组病人的CysC水平差异. 结果:被调查DN病人中营养不良发生率为74.7％,血CysC水平与血红蛋白、清蛋白、肱三头肌皮皱厚度、淋巴细胞计数呈负相关. 结论:DN病人的营养不良发生率较高,与DN肾功能损害程度、膳食结构不合理密切相关.其营养状况与血CysC水平存在相关性.DN病人血CysC水平升高者尽早进行营养干预,防止或减缓营养不良和其他并发症的发生.     

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.     

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.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

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.