脓疱疮患儿皮肤感染金黄色葡萄球菌的耐药性研究

目的观察和分析患儿皮肤感染金黄色葡萄球菌的耐药性,为临床选择适当的抗菌药物提供参考依据。方法选取2010年1月-2012年12月246例脓疱疮皮肤感染患儿作为研究对象,对其送检感染分泌物标本检出的金黄色葡萄球菌进行分离、培养和耐药性检测,菌株通过触酶试验、血浆凝固酶试验及革兰染色进行菌种鉴定,用琼酯稀释法进行药敏试验。结果在脓疱疮分泌物中分离培养出246株金黄色葡萄球菌,其对青霉素、红霉素和克林霉素的耐药率较高,分别为94.7%、86.6%和75.6%,其中对青霉素的耐药率呈现逐年上升的趋势;对苯唑西林、环丙沙星、庆大霉素的耐药率较低,分别为0.8%、4.5%、15.8%,未发现对头孢菌素、莫匹罗星、夫西地酸和万古霉素耐药菌株。结论引发脓疱疮的金黄色葡萄球菌对青霉素等抗菌药物的耐药率较高,应加强对其耐药性的监测,临床医师应根据监测结果选择适当的抗菌药物进行治疗。     

消毒与新生儿院内感染

目的:查明引起新生儿院内感染原因。方法:对所有接触新生儿的物品和医护人员的手进行细菌培养。结果:母婴病房接连不断近10名新生儿出生24～72h后发生自腋窝处出现米粒大小脓疱疹,并随时间延长脓疱逐渐蔓延。共采集标本53份,经鉴定共有4种标本检出了金黄色葡萄球菌,分别为新生儿3份脓疱内液体、医护人员手1例、体温计和体温计消毒液。结论:体温计和护理人员的手是携带金黄色葡萄球菌的主要因素;不规范消毒是院内感染的主要原因。     

一对母婴同时携带的金黄色葡萄球菌同源性分析

目的分析一对母婴同时携带的金黄色葡萄球菌的同源性,了解金黄色葡萄球菌在母婴之间传播的可能性。方法对分离的3株金黄色葡萄球菌（其中1株分离自受母乳喂养,患有脐炎的新生儿脐分泌物;另2株分别分离自该新生儿健康母亲左右两侧乳房分泌的乳汁）进行药敏试验表型分型和脉冲场凝胶电泳（PFGE）基因分型,分析其同源性。结果此对母婴携带的3株金黄色葡萄球菌对常用抗菌药物的药敏试验结果完全相同,PFGE图谱具有100%的相似度,PFGE结果聚类图处于同一分支。结论此对母婴携带的金黄色葡萄球菌是相同型别菌株,推测金黄色葡萄球菌在母婴之间传播的可能性大。     

新生儿皮肤脓疱疮的预防与控制

目的分析医院获得性新生儿脓疱疮发生的相关因素,前瞻性探讨其预防控制措施。方法对2007年发生在产科的64例新生儿脓疱疮病例进行回顾性调查分析,前瞻性监测2008、2009年新生儿皮肤脓疱疮发生情况,并采取一系列预防控制措施。结果 2007年感染率4.90%,出生2~3 d发生感染的占28.12%,4~5 d占60.94%,6~7 d占10.94%;干预后2008年感染脓疱疮24例,感染率1.54%,2009年感染脓疱疮32例,感染率1.59%,干预前后差异有统计学意义(χ2=1171.82、1149.22,P<0.01)。结论加强产前产道、肠道、会阴部清洁消毒,落实消毒隔离措施,强调手卫生,改善新生儿沐浴室环境及流程,可有效减少医院新生儿脓疱疮的发生。     

新生儿金黄色葡萄球菌医院感染追踪调查

目的　医院同期内发现新生儿金黄色葡萄球菌(SA)医院感染,追踪其原因。方法　对患儿、产房、病房环境、洗澡环境、医护人员的手、鼻咽拭子进行病原学调查,并对所分离的SA 测定其MRSA、药敏实验、噬菌体分型、DNA 随机引物扩增(RAPD)来追踪其同源性。结果　采集标本206 份,分离SA55 株,阳性率为38.1% ,6 例患婴均分离出SA,并有2 例合并铜绿假单胞菌感染。洗澡水及洗澡海绵取标本12 份,均培养出SA。噬菌体分型,患婴组及洗澡组均为Ⅲ型,其余环境SA 多为Ⅰ型。结论　患婴SA 和洗澡海绵SA 为同一聚类群属同源性。SA特异基因PCR 诊断与耐药基因测定对追踪同源性意义不大     

产前阴道分泌物与医院感染的关系探讨

目的 探讨孕妇阴道分泌物与医院新生儿感染的关系。方法 选择1999年3－4月在我院待产或临产的75例阴道分泌物做细菌培养并追踪新生儿感染的发病率。结果 近期性生活的孕妇阴道金黄色葡萄球菌检出率为88％，破膜12h以上金黄色葡萄球菌检出率明显增高达64％，阴道携带金黄色葡萄球菌的孕妇其新生儿感染率高达55％。结论 阴道分泌物中金黄色葡萄球菌的检出与性生活及胎膜早破等因素有关，而金黄色葡萄球菌与院内新生儿感染有密切关系，我们真对该感染原因提出相应的预防措施。     

新生儿病房分离金黄色葡萄球菌耐药性及耐消毒剂基因检测

目的了解新生儿病房送检标本中金黄色葡萄球菌的耐药谱及耐消毒剂基因携带情况。方法收集2013年1—12月某院新生儿病房住院新生儿送检标本分离的金黄色葡萄球菌,采用VITEK2 Compact细菌鉴定分析系统进行细菌鉴定及药敏试验,采用聚合酶链反应(PCR)检测耐消毒剂qacA/B基因。结果新生儿科送检标本中共分离225株金黄色葡萄球菌,主要来源于呼吸道(72.44%)和脐部分泌物(14.33%);耐甲氧西林金黄色葡萄球菌(MRSA)检出率为8.89%(20株);耐药监测中,MRSA的耐药率普遍高于甲氧西林敏感金黄色葡萄球菌(MSSA)。左氧氟沙星、莫西沙星、替加环素、万古霉素、利奈唑胺及呋喃妥因对所有金黄色葡萄球菌均显示出良好的抗菌活性,敏感率均为100%。携带qacA/B基因的金黄色葡萄球菌有21株,阳性率为9.33%,其中MRSA3株(15.00%),MSSA18株(8.78%)。结论新生儿病房分离的MRSA耐药严重,同时携带qacA/B基因,应引起临床重视。     

某院金黄色葡萄球菌感染PFGE溯源分析

目的利用脉冲场凝胶电泳(pulsed field gel electrophoresis,PFGE)技术对某院新生儿室发生的1例金黄色葡萄球菌院内感染进行调查和溯源分析。方法对某院新生儿室环境和新生儿室患者样本进行采样和细菌培养。对金黄色葡萄球菌采用PFGE检测技术进行分子分型。结果医生工作站电脑键盘分离出1例金黄色葡萄球菌,新生儿病房环境监测未发现金黄色葡萄球菌。PFGE分析显示,未分离出与院内感染株同源的菌株。结论应用PFGE技术对新生儿病区的院内感染株进行监测,新生儿病区并未发生金黄色葡萄球菌院内感染株的暴发流行。     

糖尿病患者鼻腔金黄色葡萄球菌携带及耐药性分析

目的了解糖尿病患者鼻腔金黄色葡萄球菌的携带及耐药情况.方法无菌生理盐水棉签前鼻庭取样,直接接种于甘露醇高盐琼脂平板,分离金黄色葡萄球菌,对分离菌株行纸片药敏检查.结果鼻腔金黄色葡萄球菌的总携带率为20.5%,MRSA的携带率为0.5%;分离菌株对万古霉素、阿米卡星、利福平、头孢唑林、环丙沙星和左氧氟沙星敏感率高,对青霉素、红霉素和克林霉素等敏感率较低.结论糖尿病患者鼻腔有较高的金黄色葡萄球菌携带率,但MRSA携带率低,携带的菌株对青霉素和红霉素以外的多数抗菌药物敏感.     

医护人员洗手后葡萄球菌带菌的调查

目的了解我院医护人员手携带葡萄球菌状况,以便采取有效地消毒措施控制医院感染.方法由临床各科医院感染监控员采集手标本送检,葡萄球菌鉴定及药敏试验按<全国临床检验操作规程>进行.结果 742份标本检出葡萄球菌11种209株,阳性检出率占28.2%,其中表皮葡萄球菌、金黄色葡萄球菌、人葡萄球菌检出率最高,分别占41.1%、22.0%、14.8%;金黄色葡萄球菌对青霉素、苯唑西林、复方新诺明、红霉素耐药率分别＞91.9%、71.8%、63.6%、79.9%,未发现耐万古霉素株;且凝固酶阴性葡萄球菌(CNS)耐药率高于金黄色葡萄球菌.结论消毒清洗后医护人员手仍有较高的葡萄球菌携带率,其耐药谱与临床感染株基本相同,因此,应采取有效措施,切实控制.     

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.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Empathic processes: perception by medical students of patients'' anxiety and depression

Perceptions by medical students of patients' affective states were investigated, and the effect of the students' own emotions on such perceptions. One hundred and one fourth-year medical students rated the levels of anxiety and depression of three women patients presented on videotape, rated their own levels of anxiety and depression and completed a questionnaire on aspects of the rating process. Students had widely different and often inappropriate perceptions of patients' levels of anxiety and depression. Students who consistently overrated anxiety or depression in patients, compared to those who consistently underrated, were themselves significantly more anxious or depressed. These data suggest a need in medical education for systematic teaching of empathic skills and for recognition of potential bias in clinical decision-making arising from the clinician's own emotional state.     

The reported incidence of work-related ill-health in Scotland (2002-2003)

BACKGROUND: Although incidence data for work-related ill-health in the UK are available, more detailed information for smaller geographical areas has hitherto been unpublished. AIMS: To estimate the incidence of work-related ill-health reported by clinical specialists in Scotland, 2002-2003. METHODS: THOR (The Health and Occupation Reporting network) is a UK wide reporting scheme for work-related ill-health. In 2002-2003, 241 out of 2162 physicians in THOR were based in Scotland. We have summarized the reported cases and calculated incidence rates for categories of ill-health by age, gender and industry. The UK Labour Force Survey (2002) was used to provide denominator data, with comparisons made between rates for Scotland and the rest of the UK. RESULTS: In 2002-2003, 4043 estimated cases were reported from Scotland. Mental ill-health was most frequently reported (41%); followed by musculoskeletal disorders (31%), skin disorders (16%), respiratory disease (10%), hearing disorders (2%) and infection (1%). The reported average annual incidence rate per 100,000 employees for all work-related ill-health in Scotland was 86.0. The highest reported rate for mental ill-health was found for employees in public administration and defence (76.7 per 100,000), and health and social work (72.3 per 100,000). The construction industry had the highest reported rate of musculoskeletal disorders (41.6 per 100,000), while hairdressers appeared at most risk of developing occupational contact dermatitis (rate=86.4 per 100,000). CONCLUSIONS: Despite its limitations, THOR has indicated types of work-related ill-health and related industries for targeted disease prevention in Scotland.     

Function of the protein RPE65 in the visual cycle

A protein called RPE65 performs a key role in the trans-cis isomerization of retinol in the retinal pigment epithelium of the eye. The palmitoylation of RPE65 serves to switch off the visual cycle in darkness and to switch it on in the light.     

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.     

Acute symptoms following work with pesticides

BACKGROUND: Serious accidental poisoning by pesticides is rare in the UK, but more minor pesticide-related illness may be under-reported. Anecdotally, use of sheep dip has been linked with flu-like symptoms. AIM: To explore the frequency, nature and determinants of acute symptoms following work with pesticides. METHODS: A postal survey of men in three rural areas of England and Wales provided data on occupational use of five categories of pesticide, occurrence of 12 specified symptoms within 48 h of using pesticides and tendency to somatize. Risk factors for pesticide-related symptoms were assessed by modified Cox regression. RESULTS: Of 10 765 responders (response rate = 31%), 4108 had at some time used pesticides occupationally, including 935 (23%) who reported symptoms following such work on at least one occasion. In two areas, acute symptoms were most frequent following use of sheep dip (29 and 32% of users), but in the third area the rate was significantly lower (13% of users). The relative frequency of symptoms was similar for all five categories of pesticide, and flu-like symptoms did not cluster unusually among users of sheep dip. Risk of pesticide-related symptoms increased with somatizing tendency (prevalence ratio for highest versus lowest category 2.4, 95% confidence interval 2.0-3.0) and was higher in men who had used pesticides most often or handled concentrate. CONCLUSION: Acute symptoms are common following work with pesticides, but in many cases the illness may arise through psychological rather than toxic mechanisms.