塞麦尔维斯(1818—1865)──一心为产妇的安全研究产褥热病因和预防的临床医学专家

在现代医学里，如果产妇分娩后发生了产得热，被认为是接产者的一件事故。可是150多年前细菌学没有诞生，人们还不知道产得热的机理，作为一个普通的产科医生，用他对病人无限的负责精神和业务中富有逻辑思维的观察能力，终于发现了产褥热的病因．并发明了预防该病的方法，他就是塞麦尔维斯（lgylazPhilipSemmdweis）。公元1844年4月奥地利首都维也纳公立医院第一产房208名产妇中，有36名因产褥热而死亡。在以后的2年里，产妇成群结队地死去，单在1846年，死于此病者竟达451名，有些月份病死率高达30％。这件事成了当地公众注意的焦点，舆…     

产科医生塞麦尔维斯的故事

今天,洗手的行为已经成为每个人生活中必须遵守的习惯,而对于工作在医院里的医生来说,何时洗手、如何洗手、不同情况下怎样洗手与普通百姓的洗手概念完全不同。产科医生伊格兹.塞麦尔维斯(Ignaz Semmelweis)是第一个教会医生洗手的人。1818年,塞麦尔维斯出生在匈牙利的布达佩斯。1844年,他完成学业并选择了产科学作为自己的研究方向,两年后,塞麦尔维斯来到维也纳总医院产科病房工作。维也纳总医院的产科病房有两个病区,病区设施类似,最大的不同是一病区由医生和实习医生负责接生,二病区由助产士负责     

为“洗一下手！”付出的生命代价

伊格纳兹·塞梅尔维斯,1818年生于布达佩斯,是一名产科医生。作为一名年轻的见习医生,他在维也纳的一家妇产科医院工作。在那里他有了令人震惊的发现:有十分之一的产妇死于产褥热。他们都是穷人。而在家里生产的富有的产妇们,远没有这样的死亡比例。塞梅尔维斯仔细观察了医院的日常工作。开始怀疑是医生造成了病人的感染。他注意到,医生常常解剖完尸体,就从停尸房直接回到产房对产妇进行检查。因此他建议,作为一项实验,让医生在接触产妇之前洗一下手。洗一下手,对于医生来说,是举手之劳。可是,要知道,这个建议是塞梅尔维斯提出的,而塞梅尔维…     

医院感染的流行病学

近二、三十年以来,在工业发达的国家里,逐渐注意到在病人住院过程中发现的各种感染,这对住院患者增加了负担,且有的造成不必要的死亡。实际上,早在1847年,奥地利妇产科医师Semmelweis经过长期观察:住在医师负责的病房中的产妇,在正常分娩后常发生产褥热;而住在助产士接生的病房中的产妇很少发病。经过分析他认为这是因为医师多亲自做尸体解剖,而在解剖后即回到病房检查及治疗病人。他提出用氯化钙水洗作为消毒之用,从而消灭了医院中产褥热的流行。这就是     

翻阅·健康日历

<正>1801年7月14日,生理学家弥勒出生于德国的科布伦茨,弥勒最主要的著作是《人体生理学概论》。1818年7月1日,被誉为"母亲救星"的伟大医学家泽梅尔魏斯诞生于匈牙利布达佩斯。1847年,他发现产褥热病因,并开始使用氯消毒法,挽救了无数产妇的生命。     

新妈睡眠的逆袭

正"白天黑夜连轴转"说的恐怕就是新手妈妈这群人,哭闹、吃奶、换尿布,小主们像"开挂"一样,就是跟各位娘亲的睡眠过不去。本期就与大家分享一些小经验,帮你赢得更多连续睡眠。TIPS关于产后护理误区1产妇房间门窗紧闭不可取很多人都以为产妇怕风,认为风是"产后风"(产褥热)的祸首。因而将房舍门窗紧闭,其实,产褥热的原因乃是藏在产妇生殖器官里的致病菌,多源于消毒不严格的产前检查等。实际上,如果室内卫生环     

开创我国现代妇幼卫生事业的先驱杨崇瑞博士

<正> 杨崇瑞,字雪丰,1891年9月6日出生在河北省通县农村的一个普通农民家庭。1910年她以优异的成绩毕业于北京贝满书院(后为贝满女中一女12中—166中),考升协和女子大学;半年后被保送北京协和医学堂专修医学。1917年毕业时,她名列前茅,荣获医学博士学位。毕业后她志愿列山东省德州博济医院工作,曾奔赴华北黄泛灾区为灾民和贫苦农民医疗服务。同时,她热情宣传妇幼卫生知识,是我国最早把现代卫生知识送往农村的人。1922年杨崇瑞入协和医学院进修,继而被选聘在妇产科做医师工作。其间,她工作认真,悉心钻研,深得病人信赖。实习期间,她曾到河北省遵化、三河县一带调查,了解到当时新生儿中的破伤风死亡率和产妇产褥热的死亡率很高,这使她意识到作为一名妇产科医生的严肃责任,于是,她开始致力于预防产妇产褥热和新生儿破伤风的工作。她利用医院临床之暇,兼办社会服务,既积极医治患者,更注重服务大众,认识到预防工作的重要。她先在北京朝阳门外设立了孕妇检查所,专门从事妇女孕期检查及妇科检查治疗;尔后又在北京灯市口慈商工厂设诊所,专为女工和孕妇检查和治疗服务。     

运用标点地图法寻找霍乱流行真相:约翰·斯诺

约翰·斯诺(John Snow,1813-1858),是麻醉医学和流行病学界举足轻重的人物。他通过调查证明霍乱经患者粪便污染的水传播,首次提出霍乱的防治措施,阻止了19世纪英国霍乱蔓延。1854年,他对伦敦索霍区霍乱暴发的调查创造性地使用了对比分析,使现场调查在医学研究中具有独特的意义。"霍乱流行图"的绘制也使标点地图法成为流行病学一项基本研究方法,斯诺也因此被誉为"流行病学之父"。     

孕妇学校规范化健康教育对产妇产褥期行为的影响

产后个人保键和婴儿保健是产褥期行为健康教育的主要内容,而产褥期行为将直接影响产妇及婴儿的健康[1].然而,许多产妇由于受传统"坐月子"观念的影响,一直遵循着传统"坐月子"的习惯,即产褥期间不能洗头、洗澡、刷牙;不能吃蔬菜、水果;也不能到室外活动等.这些行为均不利于产妇与婴儿的健康,且易发生产褥热和乳腺炎等疾患.为此,我科尝试通过孕妇学校规范化健康教育向孕产妇传达正确的产褥期观念,以改善其产褥期行为,促进产妇的产后恢复及身心健康.     

产褥感染和产褥期疾病

正产妇分娩后的42天属于产褥期。产褥期为女性生育后生殖器官恢复的时期,也是妇女一生中生理及心理发生急剧变化的时期之一。在产褥期间,由于多种原因,产妇极易遭受产褥感染,罹患产褥热、产后HELLP综合征等各种令人恐惧的疾病。在旧中国,产褥热是造成产妇死亡的严重疾病之一。即使在今天,产褥热仍然令人生畏。为加强产褥期护理,我们有必要了解产褥感染与产褥期疾病。     

Semmelweis and the aetiology of puerperal sepsis 160 years on: an historical review

It is generally accepted that Professor Ignaz Semmelweis was the first to identify the mode of transmission of puerperal sepsis. However no appropriate statistical analysis of Semmelweis's data supporting his theory has been reported. Mean annual percent maternal mortality rates for the Allgemeines Krankenhaus and Dublin Maternity Hospitals (1784-1858) were analysed. The introduction of pathological anatomy at the Allgemeines Krankenhaus in 1823 was associated with increased mortality. After 1840 maternal mortality was higher in Clinic 1 which was staffed by male obstetricians and medical students who, unlike the midwives in Clinic 2, attended autopsies. The introduction of chlorine washing of the male clinicians' hands in Clinic 1 by Semmelweis in 1847 reduced mortality, whereas the cessation of handwashing after Semmelweis left Vienna in 1850 was associated with increased mortality. This statistical analysis supports Semmelweis's hypothesis that 'the cadaveric particles adhering to the hand had ... caused the preponderant mortality in the first Clinic'.     

Maternal Death Review at a Tertiary Hospital in Ethiopia

BackgroundThere is conflicting data on the rate and trends of maternal mortality in Ethiopia. There is no previous study done on the magnitude and trends of maternal death at Saint Paul''s Hospital, an institution providing the largest labor and delivery services in Ethiopia. The objective of this study is to determine the magnitude, causes and contributing factors for maternal deaths in the institution.MethodsWe conducted a retrospective review of maternal deaths from January 2016 to December 2017. Data were analyzed using SPSS version 20.ResultsThe maternal mortality ratio of the institution was 228.3 per 100,000 live births. Direct maternal death accounted for 90% (n=36) of the deceased. The leading causes of the direct maternal deaths were hypertensive disorders of pregnancy (n=13, 32.5%), postpartum hemorrhage (n=10, 25%), sepsis (n=4, 10%), pulmonary thromboembolism (n=3, 7.5%) and amniotic fluid embolism (n=3, 7.5%).ConclusionThe maternal mortality ratio was lower than the ratios reported from other institutions in Ethiopia. Hypertensive disorders of pregnancy and malaria were the leading cause of direct and indirect causes of maternal deaths respectively. Embolism has become one of the top causes of maternal death in a rate like the developed nations. This might show the double burden of embolism and other causes of maternal mortality that developing countries might be facing.     

Maternal mortality in a rural district of southeastern Tanzania: an application of the sisterhood method

BACKGROUND: Deaths from maternal causes represent the leading cause of death among women of reproductive age in most developing countries. It is estimated that the highest risk occurs in Africa, with 20% of world births but 40% of the world maternal deaths. The level of maternal mortality is difficult to assess especially in countries without an adequate vital registration system. Indirect techniques are an attractive cost-effective tool to provide estimates of orders of magnitude for maternal mortality. METHOD: The level of maternal mortality estimated by the sisterhood method is presented for a rural district in the Morogoro Region of Southeastern Tanzania and the main causes of maternal death are studied. Information from region-specific data using the sisterhood method is compared to data from other sources. RESULTS: The maternal mortality ratio (MMR) was 448 maternal deaths per 100,000 live births (95%CI : 363-534 deaths per 100,000 live births). Maternal causes accounted for 19% of total mortality in this age group. One in 39 women who survive until reproductive age will die before age 50 due to maternal causes. The main cause of death provided by hospital data was puerperal sepsis (35%) and postpartum haemorrhage (17%); this is compatible with the main causes reported for maternal death in settings with high levels of maternal mortality, and similar to data for other regions in Tanzania. The sisterhood method provides data comparable with others, together with a cost-effective and reliable estimate for the determination of the magnitude of maternal mortality in the rural Kilombero District.     

Vanadium in Ambient Air: Concentrations in Lung Tissue from Autopsies of Mexico City Residents in the 1960s and 1990s

Vanadium concentrations in lung tissue were determined by atomic absorption spectrometry from autopsy specimens taken from residents of Mexico City during the 1960s and 1990s (20 males and 19 females, and 30 males and 18 females, respectively). Samples from the 1990s had significantly increased mean vanadium concentrations (mean ± standard deviation: 1.36 ± 0.08), compared with those from the 1960s (1.04 ± 0.05). Concentrations were not correlated with gender, smoking habit, age, cause of death, or occupation. These findings suggest that vanadium in ambient air is increasing and it represents a potential health hazard for Mexico City residents. Air pollution monitoring efforts should include vanadium concentrations in suspended particles to follow-up the findings reported herein. Researchers need to acquire a better knowledge of the levels of airborne vanadium exposure at which risk to human health occurs.     

Validity of maternal and perinatal risk factors reported on fetal death certificates

We sought to estimate the accuracy, relative to maternal medical records, of perinatal risk factors recorded on fetal death certificates. We conducted a validation study of fetal death certificates among women who experienced fetal deaths between 1996 and 2001. The number of previous births, established diabetes, chronic hypertension, maternal fever, performance of autopsy, anencephaly, and Down syndrome had very high accuracy, while placental cord conditions and other chromosomal abnormalities were reported inaccurately. Additional population-based studies are needed to identify strategies to improve fetal death certificate data.     

Public Reaction to the Death of Steve Jobs: Implications for Cancer Communication

The present study aimed to examine the public reaction to the death of Steve Jobs, focusing on general and cancer-specific information seeking and interpersonal communication. Shortly after Jobs's death, employees from a large university in the Southeastern United States (N = 1,398) completed a web-based survey. Every employee had heard about Steve Jobs's death, and 97% correctly identified pancreatic cancer as the cause of his death. General (50%) and pancreatic cancer–specific (7%) information seeking, as well as general (74%) and pancreatic cancer–specific (17%) interpersonal communication, took place in response to Steve Jobs's death. In multivariate logistic regression analyses controlling for demographics and several cancer-oriented variables, both identification with Steve Jobs and cancer worry in response to Steve Jobs's death significantly (p < .05) predicted pancreatic cancer information seeking as well as interpersonal communication about pancreatic cancer. Additional analyses revealed that cancer worry partially mediated the effects of identification on these outcome variables. Implications of these results for future research as well as cancer prevention and communication efforts are discussed.     

The effects of spatial population dataset choice on estimates of population at risk of disease

Background

Verbal autopsy can be a useful tool for generating cause of death data in data-sparse regions around the world. The Symptom Pattern (SP) Method is one promising approach to analyzing verbal autopsy data, but it has not been tested rigorously with gold standard diagnostic criteria. We propose a simplified version of SP and evaluate its performance using verbal autopsy data with accompanying true cause of death.

Methods

We investigated specific parameters in SP's Bayesian framework that allow for its optimal performance in both assigning individual cause of death and in determining cause-specific mortality fractions. We evaluated these outcomes of the method separately for adult, child, and neonatal verbal autopsies in 500 different population constructs of verbal autopsy data to analyze its ability in various settings.

Results

We determined that a modified, simpler version of Symptom Pattern (termed Simplified Symptom Pattern, or SSP) performs better than the previously-developed approach. Across 500 samples of verbal autopsy testing data, SSP achieves a median cause-specific mortality fraction accuracy of 0.710 for adults, 0.739 for children, and 0.751 for neonates. In individual cause of death assignment in the same testing environment, SSP achieves 45.8% chance-corrected concordance for adults, 51.5% for children, and 32.5% for neonates.

Conclusions

The Simplified Symptom Pattern Method for verbal autopsy can yield reliable and reasonably accurate results for both individual cause of death assignment and for determining cause-specific mortality fractions. The method demonstrates that verbal autopsies coupled with SSP can be a useful tool for analyzing mortality patterns and determining individual cause of death from verbal autopsy data.     

新疆生产建设兵团1999—2008年孕产妇死亡情况分析及干预措施

目的分析新疆兵团10年来孕产妇死亡的主要原因。方法对兵团1999—2008年死亡的86例孕产妇死亡资料进行分析。结果 10年来兵团常住孕产妇死亡共86例,平均孕产妇死亡率为61.47∕10万。孕产妇死亡的主要原因为:产科出血29例,占33.72%;内科合并症21例,占24.42%;羊水栓塞20例,占23.26%;妊娠期高血压疾病9例,占10.47%;产褥感染3例,占3.49%;外科合并症3例,占3.49%;不明原因1例,占1.16%。结论制订有效的干预措施降低孕产妇死亡率。