170例巨大胎儿临床分析

目的：探讨巨大胎儿的产前诊断及分娩方式,降低母儿并发症。方法：回顾分析170例巨大胎儿的临床资料,并抽取同期分娩正常体重儿的足月孕妇作为对照组。结果：胎儿BPD、FL,产妇宫高、腹围等是诊断巨大胎儿的相关因素。超声下的BPD＋FL≥165mm或宫高＋腹围≥140cm可作为产前诊断巨大胎儿的一项可靠指标,巨大胎儿的分娩方式以剖宫产相对安全。结论：加强孕期监护,预防巨大胎儿的发生,选择正确的分娩时机与分娩方式,可降低母婴并发症,保障母婴安全。     

产妇身高与巨大胎儿分娩方式关系的探讨

近几年来 ,巨大胎儿发生率在 8%左右 ,居高不下。国内不少学者进行了巨大胎儿的相关因素分析 ,以期待通过产前检查预测巨大胎儿 ,希望通过适时的干预措施 ,达到降低母婴分娩时并发症的发生率。本文对我院 2 0 0 2年度分娩的 177例巨大胎儿产妇的身高与巨大胎儿分娩方式作回顾性分析。1　资料与方法1.1　一般资料我院 2 0 0 2年 1～ 12月单胎分娩的产妇共 2 15 6例 ,其中初产妇 2 13 4例 ,经产妇 2 2例。 177例巨大胎儿中 ,经产妇 2例。分娩时孕周≥ 3 7周。无 1例母婴远期并发症发生。1.2　诊断标准巨大胎儿诊断以新生儿出生时体重≥ 40 0 0…     

168例巨大胎儿临床分析

目的:通过对168例巨大胎儿的临床分析,寻找准确诊断巨大胎儿的相关因素。方法:将168例巨大胎儿(出生体重≥4 000 g)作为观察组;随机选择同期住院分娩168例出生体重<4 000 g的正常足月儿作为对照组。比较孕产妇产次、孕周、身高、体重、宫高、腹围、分娩并发症、分娩方式、B超检测胎儿双顶径(BPD)及股骨长径有关情况。结果:巨大胎儿组母亲身高、孕期体重、分娩孕周、孕产次、分娩并发症均高于对照组,并有统计学差异。巨大胎儿组分娩方式以剖宫产为主,剖宫产率75.0%,高于对照组29.2%。结论:产妇身高、体重、分娩孕周及宫高、腹围是产前诊断巨大胎儿的相关因素。超声检查预测巨大胎儿有参考价值。巨大胎儿的分娩方式以剖宫产相对安全。     

551例巨大胎儿分娩方式探讨

胎儿出生体重≥4 000 g为巨大儿,若处理不当可引起严重的母儿并发症.本文回顾我院2007年5月1日～12月31日住院分娩的551例巨大胎儿,寻求诊断巨大胎儿的相关因素.     

197例巨大胎儿临床分析

目的:通过对197例巨大胎儿的临床分析,寻找准确诊断巨大胎儿的相关因素。方法:将197例巨大胎儿(出生体重≥4 000 g)纳入研究,选择相应时间(2 d内)分娩的197例出生体重<4 000 g的正常足月儿作为对照;比较孕妇年龄、身高、体重、孕周、孕产次、分娩方式、合并症及新生儿有关情况。结果:巨大胎儿组母亲身高、孕期体重增长、分娩孕周、孕产次均高于对照组,并有统计学差异。巨大胎儿男婴多于女婴。巨大胎儿组分娩方式以剖宫产为主,剖宫产率为71.6%,高于对照组(33.0%)。结论:产妇体重、身高、分娩孕周及宫高、腹围是产前诊断巨大胎儿的相关因素。超声检查对估计巨大胎儿有参考价值。巨大胎儿的分娩以剖宫产相对安全。     

巨大胎儿相关因素分析及降低母婴并发症防治措施探讨

目的 分析发生巨大胎儿的相关因素,探讨降低母婴并发症的预防措施.方法 对128例分娩巨大胎儿产妇(巨大胎儿组)与138例分娩正常体重儿产妇(对照组)的产次、妊娠前后体重变化、孕周、胎头双顶径、股骨长度、宫高+腹围、妊娠期合并症及并发症、母婴并发症、分娩方式等进行回顾性对比分析.结果 诊断符合率为96.20％(2001/2080),巨大胎儿组经产妇、孕前肥胖、妊娠期体重增加≥20 kg、胎头双顶径≥9.5cm、股骨长度≥7.5cm、宫高+腹围≥140 cm、妊娠期糖尿病、妊娠期高血压、过期妊娠、孕周＜ 37周、孕周≥42周比例与对照组比较差异均有统计学意义(P＜0.05)；巨大胎儿组的产后出血、软产道损伤、肩难产、胎儿窘迫、新生儿窒息发生率分别为17.97％(23/128)、7.03％(9/128)、3.91％(5/128)、19.53％ (25/128)、6.25％(8/128),显著高于对照组的8.70％(12/138)、3.62％ (5/138)、0.72％ (1/138)、9.42％ (13/138)、1.45％(2/138),差异有统计学意义(P＜0.05)；巨大胎儿组的择期剖宫产、阴道试产失败发生率分别为76.56％(98/128)、11.72％(15/128),显著高于对照组的20.29％(28/138)、3.62％(5/138),差异有统计学意义(P＜0.05).结论 妊娠期采取有效的预防措施可以降低巨大胎儿的出生率,降低巨大胎儿产时母婴并发症.     

巨大胎儿118例临床分析

目的探讨巨大胎儿对母体的影响,以降低母婴并发症,提高产科质量。方法将巨大胎儿118例设为巨大胎儿组,另将同期分娩的正常体重儿118例设为对照组,对两组的孕周、胎儿体重、分娩方式与并发症、并发症进行比较。结果巨大胎儿组孕周明显长于对照组,分娩方式以剖宫产为主,并发症例数也远远多于对照组。结论对估计有巨大胎儿的孕妇应高度重视,积极进行产前监护,产后仔细动态观察,适时终止妊娠。     

253例巨大胎儿相关因素及产后分析

目的:探讨巨大胎儿相关因素及母婴预后情况。方法:对2003~2005年在该院建母婴系统保健卡的,并对4 527例孕产妇进行回顾性调查统计分析。结果:巨大胎儿发生率有上升的趋势,异常分娩方式高达84.08%,明显高于对照组(P<0.01),妊娠并发症、围产儿死亡率明显增高。结论:巨大胎儿危害母婴安全,必须加强母婴保健、合理膳食,预防巨大儿的发生。     

巨大胎儿相关因素及预后的临床分析

目前诊断巨大胎儿(巨大儿)标准为新生儿出生体重(NBW)≥4000g.巨大儿如不能及时诊断,采取适当分娩方式,常易导致母儿巨大创伤,如子宫破裂、软产道严重撕裂伤、新生儿窒息、颅内出血、锁骨骨折甚至死亡.我科自2007年10月到2010年9月,分娩总数6338例,其中巨大儿216例,占6.83%.为提高产前诊断巨大胎儿的准确性,现对216例巨大胎儿进行回顾性分析,从寻找识别巨大儿的相关因素,争取产前做出正确诊断,指导产程妥善处理,降低母婴并发症.     

巨大胎儿发生的原因及分娩方式探讨

目的:探讨巨大胎儿的相关因素及分娩方式,找出干预措施,降低母婴并发症。方法:回顾性分析240例巨大胎儿(观察组)临床资料,随机抽取同期240例正常足月儿为对照组。结果:巨大胎儿的发生与妊娠超体重,妊娠合并糖尿病或糖耐量异常孕妇有关。分娩方式以剖宫产为主,肩难产几率增加,产后出血发生增加。结论:妊娠期营养过剩,妊娠期血糖升高增加巨大胎儿的发生,故加强孕期指导与监护,降低巨大胎儿的发生。     

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.     

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.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.     

Stress in the Norwegian police service

BACKGROUND: High levels of stress have been attributed to the conditions of police work, but there is little empirical evidence for this. AIMS: To develop a new instrument to measure job stress in the police; to assess the most severe and frequent police stressors; to compare levels of stress according to the demographic and organizational factors; and to study stress in relation to personality traits, work locus of control and coping strategies. METHODS: A comprehensive nationwide questionnaire survey of 3272 Norwegian police at all hierarchical levels, including the Norwegian Police Stress Survey (NPSS), the Job Stress Survey, the Basic Character Inventory, the Work Locus of Control Scale, and the Coping Strategies Scale. RESULTS: Work injuries were appraised as the most stressful but least frequent stressor and job pressure was reported the least severe but most frequent stressor. Females experienced job stressors less frequently, but appraised them as more severe than men did. Older police officers reported more job pressure severity and fewer work injuries. The police in districts where peer support was planned but not implemented, and who worked in districts with more than 50,000 inhabitants, perceived the lack of support more severely than others. The correlations between stress and personality traits, work locus of control, and coping were moderate. CONCLUSIONS: The NPSS captures police-specific stressors that are not adequately measured by global stress instruments. The study of stress in police work should preferably involve a nationwide use of police-specific stress instruments.