经尿道膀胱肿瘤切除患者术后尿路感染的高危因素及病原菌分布研究

目的探讨高危因素及病原菌分布,旨在为降低高危因素、选取敏感抗菌药物以控制感染提供依据。方法选取2014年2月-2016年3月经尿道膀胱肿瘤切除术者324例,引入多因素logistic回归模型分析经尿道膀胱肿瘤切除患者术后尿路感染的高危因素,并观察尿路感染者的病原菌分布特点。结果 324例经尿道膀胱肿瘤切除患者术后尿路感染48例,感染率14.81%;年龄≥65岁、糖尿病、高血压、肿瘤位点(多发)、术前导尿、手术时间≥90min、导尿管留置≥7d、膀胱冲洗时间≥2d患者尿路感染率高,差异有统计学意义(P<0.05);引入二分类logistic回归模型,筛查出年龄≥65岁、糖尿病、肿瘤位点(多发)、术前导尿、手术时间≥90min、导尿管留置≥7d、膀胱冲洗时间≥2d是经尿道膀胱肿瘤切除术后尿路感染的独立危险因素;且尿路感染者检出革兰阴性菌39株占70.91%,革兰阳性菌15株占27.27%,真菌1株占1.82%,革兰阴性菌构成比高于其他类型,且大肠埃希菌、肺炎克雷伯菌构成比高于其他病原菌。结论年龄、糖尿病、肿瘤位点、术前导尿、手术时间、导尿管留置、膀胱冲洗时间是本地区经尿道膀胱肿瘤切除术后尿路感染的高危因素,且以革兰阴性菌为主,所以早期采用有效防控措施,正确选取敏感抗菌药物,有助于控制术后尿路感染率、促进患者早日康复。     

膀胱肿瘤经尿道电切术后尿路感染病原菌分析

目的探讨经尿道膀胱肿瘤电切术(TURBT)术后患者尿路感染原因,以期为临床TURBT术后尿路感染的预防治疗提供帮助。方法回顾性分析2009年1月-2012年12月行TURBT住院患者的临床资料、尿路感染的发生率及其影响因素、病原菌分布,采用SPSS17.0统计软件进行数据分析。结果 213例行TURBT患者术后发生尿路感染60例,感染率28.17%;共分离出68株病原菌,革兰阴性菌50株占73.5%,革兰阳性菌18株占26.5%,其中以大肠埃希菌最为常见占51.5%,其次是肺炎克雷伯菌和肠球菌属,分别占17.6%、4.4%,未分离出真菌;年龄>60岁、肿瘤位点多发患者、有糖尿病史、术前有留置导管、白细胞数低、术前使用抗菌药物数量少是TURBT术后尿路感染的危险因素(P<0.05),而性别、细胞分型以及慢性支气管炎史对其影响不明显。结论 TURBT术后感染的发生率较高,以革兰阴性菌感染为主,多种相关因素与TURBT术后发生感染有关,性别、细胞分型以及慢性支气管炎史与术后发生感染无显著相关。     

脑梗死后神经源性膀胱留置尿管相关性尿路感染的研究

目的 分析脑梗死后神经源性膀胱留置尿管相关性尿路感染的病原菌特点及相关因素,为预防尿路感染提供理论依据.方法 采用回顾性调查的方法,对2009年10月-2011年9月康复科收治96例脑梗死后神经源性膀胱留置尿管患者的资料,分析留置尿管期间引起尿路感染的病原菌特点及主要原因,探讨控制措施.结果 96例脑梗死后神经源性膀胱患者早期进行留置尿管,1个月中发生尿路感染病例60例,分离出85株病原菌,革兰阴性杆菌49株,占57.7％,以大肠埃希菌为主;革兰阳性球菌16株,占18.8％,以肠球菌属为主;真菌20株,占23.5％,以白色假丝酵母菌为主;感染原因主要有4方面:抗菌药物过度使用;医护人员与陪护人员的手卫生不规范;糖尿病患者血糖控制不理想;留置尿管时间长.结论 脑梗死后神经源性膀胱留置尿管期间应合理使用抗菌药物;积极控制血糖;加强医护人员与陪护人员手卫生;早日解除留置导尿改为间歇导尿方法,积极锻炼膀胱功能,尽早建立反射性膀胱是关键;降低尿路感染的发生率,从而提高患者的生活质量.     

前列腺切除术后尿路感染的原因分析及预防对策

目的调查分析前列腺切除术后尿路感染的原因,并探讨预防措施。方法采用回顾性方法,调查2006年1月-2009年12月行前列腺切除术患者尿路感染的发生情况。结果 332例患者共发生尿路感染126例,发生率38.0%;共分离病原菌147株,革兰阴性杆菌93株,占63.3%,革兰阳性球菌42株,占28.6%,真菌12株,占8.1%;前列腺切除术后发生尿路感染与原发病导致尿液滞留、留置尿管、留置时间过长等因素有关。结论加强留置导管的护理,控制留置导尿时间,提倡生理性膀胱冲洗和加强术后的心理护理是减少前列腺切除术后尿路感染发生的有效措施。     

经尿道膀胱肿瘤切除术后尿路感染病原学分析

目的分析经尿道膀胱肿瘤切除(TURBT)术后尿路感染患者的病原菌分布及耐药性,探讨诊治的有效方法。方法选择2010年3月-2013年3月62例膀胱肿瘤患者资料进行回顾性分析,所有患者治疗方法均为经尿道膀胱肿瘤切除术,取尿液进行培养及药敏试验,并对诊治方法及效果进行评价。结果 62例TURBT术后尿路感染患者中段尿培养出病原菌71株,其中革兰阴性杆菌50株占70.4%,革兰阳性球菌17株占24.0%,真菌4株占5.6%;前3位的病原菌分别为大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌,分别占33.8%、15.5%、9.9%;大肠埃希菌、肺炎克雷伯菌对临床常用的广谱抗菌药物高度耐药,对头孢哌酮/舒巴坦、美罗培南、亚安培南耐药率较低,均<10.0%,革兰阳性菌对临床常用抗菌药物耐药率均>60.0%,未发现耐万古霉素菌株;所有患者在经验用药基础上调整,感染均得到控制,无1例患者死亡。结论经尿道膀胱肿瘤切除术后尿路感染的主要病原菌是革兰阴性杆菌,病原菌耐药现象日趋严重,加强基础疾病的治疗,合理选择抗菌药物,是治疗术后尿路感染的主要策略。     

妇科老年患者卵巢癌术后尿路感染的临床分析

目的 了解老年女性尿路感染的特点,分析其易感因素,从而指导临床治疗和护理,降低尿路感染发生率.方法 对医院2008年1月-2011年12月行卵巢癌手术136例患者的尿路感染的发生进行分析.结果 136例患者共发生尿路感染49例,发生率36.03％；临床表现以尿路刺激征为多见,阳性率为57.14％;共分离病原菌49株,革兰阳性球菌25株,占51.02％,革兰阴性杆菌23株,占46.94％,真菌1株,占2.04％；通过对比尿路感染组与非尿路感染组患者发现,卵巢癌术后发生尿路感染与原发病导致尿液潴留、插管次数、留置时间过长、合并基础疾病等因素有关,差异有统计学意义(P＜0.05).结论 加强留置导管的护理、控制留置导尿时间、严格无菌技术操作,提倡生理性膀胱冲洗和加强术后的心理护理是减少卵巢癌术后尿路感染发生的有效措施.     

经尿道等离子前列腺切除患者术后尿路感染的影响因素分析

目的探讨经尿道等离子前列腺切除患者术后尿路感染的影响因素。方法选择2015年4月-2017年2月医院泌尿外科收治的经尿道等离子前列腺切除术的前列腺增生患者180例为研究对象,均行经尿道等离子前列腺切除术,围术期均实施相应护理干预。统计患者术后尿路感染发生率;对发生尿路感染患者的尿液进行病原菌培养及鉴定;统计患者的年龄、糖尿病、术前留置导尿管、手术时间、术后留置导尿时间等临床资料,对术后发生尿路感染的相关影响因素进行单因素及多因素分析。结果 180例行经尿道等离子前列腺切除术的前列腺增生患者中,共30例患者术后发生尿路感染,感染发生率为16.67%;30例尿路感染患者尿液共培养鉴定病原菌30株,其中革兰阴性杆菌26株占86.67%、革兰阳性球菌4株占13.33%;多因素Logistic回归分析结果显示,年龄70岁、合并糖尿病、术前留置导尿管、术后留置导尿管时间7d,抗菌药物应用时间≤48h、手术时间90min、常规护理为术后发生尿路感染的影响因素(P0.05)。结论糖尿病、术前(术后)留置导尿管、手术时间长等为经尿道等离子前列腺切除术术后发生尿路感染的影响因素,临床治疗过程中,应合理控制患者血糖、缩短手术时间及留置导尿管时间,并预防性合理应用抗菌药物,以降低术后尿路感染的发生率。     

留置尿管患者尿路感染的相关因素及预防对策

目的 分析留置尿管患者尿路感染的相关因素,并探讨预防对策,以降低尿路感染发生率.方法 运用回顾性调查方法对23例留置尿管发生尿路感染患者进行原因分析;观察不同留置尿管时间尿路感染的发生率.结果 随着留置尿管时间的增加,发生尿路感染例数显著增加,留置尿管10、20、30、＞30 d患者发生尿路感染分别占8.70％、17.39％、30.43％、43.48％ ;23例感染患者中有16例行尿培养检查,送检率为69.57％,培养结果均为阳性,分离出的病原菌以革兰阴性杆菌为主,占52.17％,其中主要为大肠埃希菌、肺炎克雷伯菌,分别占30.43％、21.74％,革兰阳性球菌占26.09％,以屎肠球菌为主,占17.39％,除此之外真菌感染增加,以白色假丝酵母菌为主,占21.74％.结论 留置尿管时间、集尿系统密闭性不良等原因是造成尿路感染的主要危险因素,针对各种危险因素,采取有效的预防措施,可降低尿路感染的发生.     

膀胱肿瘤切除术后尿路感染病原学和危险因素

目的观察膀胱肿瘤切除术后患者尿路感染发生情况与病原学特征,分析诱发尿路感染的危险因素,并提出合理且具备针对性的冲洗对策,为未来膀胱肿瘤切除术后尿路感染的预防提供合理参考。方法回顾性分析连云港市第一人民医院2016年1月-2019年1月接受经尿道膀胱肿瘤切除术治疗的451例膀胱肿瘤患者的临床资料,收集患者病例资料,全部患者术后均定期取尿液标本进行细菌培养,参照相关标准判定患者尿路感染情况,记录患者一般情况,包括一般人口学资料(性别、年龄、体质量、受教育程度等),同时记录患者糖尿病的疾病合并情况,将术后尿路感染可能的危险因素纳入初步分析,Logistic多因素回归分析膀胱肿瘤切除术后发生尿路感染的危险因素。结果451例膀胱肿瘤切除术患者术后第3天尿液中细菌培养阳性例数为80例,阳性率为17.74%,在使用抗菌药物后,患者尿液中细菌培养阳性率逐渐降低,各时点尿液细菌阳性培养率比较,差异有统计学意义(P<0.05);经多因素Logistic回归分析检验证实,高龄、血糖水平控制不佳、术前留置导尿管、多发肿瘤是膀胱肿瘤切除术后尿路感染的危险因素(OR>1,P<0.05);80例术后尿液细菌培养阳性患者共分离出87株菌株,其中革兰阴性菌66株占75.86%,革兰阳性球菌21株占24.14%。结论膀胱肿瘤切除术后患者有较高的尿路感染风险,革兰阴性菌是主要的感染病原菌,年龄、基础疾病、肿瘤位点、术前导尿管留置等是影响因素,这类患者应引起临床高度重视。     

间歇性导尿术对脊髓损伤患者尿液细菌学检测的影响

目的 探讨间歇性导尿术和留置导尿术对脊髓损伤患者尿路感染的影响.方法 对80例脊髓损伤后膀胱功能障碍出现尿潴留患者分别采用间歇导尿和留置导尿,定期尿液培养进行尿路感染率比较,采用间歇性导尿术同时进行膀胱功能训练,并分别于留置导尿、间歇性导尿后15、30 d取患者尿液进行细菌培养及鉴定.结果 间歇性导尿15、30 d的尿路感染(菌落计数≥1×10 CFU/ml)发生率分别为32.6 %和31.5%,明显低于留置导尿尿路感染发生率(100.0%),P＜0.05;尿道细菌的种类相似,主要是大肠埃希菌、产气肠杆蘸、葡萄球菌属、肺炎克雷伯菌等.结论 间歇性导尿术能降低脊髓损伤患者尿路感染的发生率,控制尿路感染、维护和促进排尿功能恢复均具有蕈要意义,但对尿道细菌的种类影响不大.     

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.     

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.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

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.