新生儿高胆红素血症医院感染特点及预防

目的了解新生儿高胆红素血症医院感染的临床特点及危险因素,预防和减少医院感染的发生。方法回顾性分析2009年1月-2012年12月儿科795例新生儿高胆红素血症患儿发生医院感染临床资料,运用SPSS13.0软件进行统计分析。结果调查795例新生儿高胆红素血症患儿发生医院感染37例、52例次,感染率4.55%、例次感染率6.54%;感染部位以呼吸道、皮肤软组织和胃肠道为主,分别占38.46%、21.15%、13.46%;早产、低体质量、住院时间长、高胆红素血症及合并症的严重程度等是医院感染的危险因素;加强预防措施后,医院感染率逐年降低,差异有统计学意义(P<0.05)。结论呼吸道、皮肤软组织和消化道是新生儿高胆红素血症患儿医院感染最主要部位,不断加强新生儿病房管理,强调医务人员洗手,重视物品、器具全面消毒,能有效降低医院感染发生率。     

延边地区新生儿黄疸原因分析

目的:探讨引起新生儿高胆红素血症的危险因素,为新生儿高胆红素血症的预防和治疗提供参考。方法:回顾性分析2010年1月～2011年5月期间于该院新生儿病房住院的高胆红素血症患儿138例,研究入选标准:出生14天之内足月儿血胆红素浓度>220.6μmol/L,出生1个月之内血胆红素浓度早产儿>255μmol/L。应用Logistic回归模型,对临床常见病因如感染、围产因素、早产、ABO溶血等进行回归分析。结果:研究组有138例,对照组有215例。肺炎、剖宫产与药物因素是引起新生儿高胆红素血症的常见原因,其次是早产与窒息。应用多因素Logistic回归分析显示,研究组与对照组相比,肺炎、新生儿窒息、颅内出血、剖宫产与药物及晚期早产因素差异存在统计学意义(P<0.05)。结论:感染和围产因素是高胆红素血症的主要原因。加强围产期保健,避免宫内感染和缺氧,提高围产技术水平,同时加强高危儿的随访及健康教育是降低高胆红素血症发生的工作重点。     

新生儿重症高胆红素血症的病因及危险因素分析

目的探讨新生儿重症高胆红素血症的病因及危险因素,为临床诊治提供参考依据。方法选择2014年1月-2016年12月航空总医院新生儿5 523例,其中重症高胆红素血症患儿128例,采用自行设计的表格,统一收集母亲、婴儿、围生三方面的因素,采用多因素回归分析探讨影响发病的危险因素。结果 128例重症高胆红素血症患儿中,感染是最常见的发病因素,占34. 38%,其次依次为不明原因(31. 25%)、早产(12. 50%)、头颅血肿(8. 59%)、溶血(7. 03%)和窒息(6. 25%);多因素Logistics回归分析显示胎龄(37周)、感染、母子血型不合是重症高胆红素血症发病的危险因素。结论感染、母子血型不合、早产是重症高胆红素血症发病的危险因素,临床上应积极制定防治措施,重视产前检查和产后访视,减少重症高胆红素血症的发生。     

新生儿医院感染的危险因素分析

目的 分析新生儿病房医院感染情况及其危险因素。 方法 回顾分析2015年1月－2017年12月安徽医科大学第二附属医院新生儿科住院的3 635例患儿的临床资料以及发生医院感染的情况。 结果 研究期间住院总新生儿人数3 635例,发生医院感染175例,181例次,医院感染率为4.81%,例次感染率为4.98%。检出病原菌49株,其中革兰阳性菌25株(51.02%),革兰阴性菌20株(40.81%),真菌4株(8.16%),前三位的病原菌分别是肠球菌属,大肠埃希氏菌及肺炎克雷伯氏菌。医院感染的部位以上呼吸道及胃肠道为主。出生体重≤1 500 g、胎龄≤32周、出生合并窒息、住院时间超过10 d、孕母合并胎膜早破、住院期间使用呼吸机、住院期间深静脉置管、肠外营养其医院感染发生率高,差异均有统计学意义(均P<0.01)。 结论 出生体重低、胎龄小、出生合并窒息、住院时间长、孕母合并胎膜早破、住院期间使用呼吸机、住院期间深静脉置管、肠外营养等均是影响新生儿感染发生的危险因素,针对危险因素制定有效预防措施,对于超低及极低出生体重儿保护性隔离,尽量减少侵袭性操作及严格执行无菌操作,注意加强深静脉置管、呼吸机管道及患儿气道护理,减少二重感染的发生,并尽量缩短留置各种管道时间,近早开始建立肠内喂养,加强静脉营养支持,缩短住院时间,尽量避免预防性抗菌药物应用,并加强对于耐药菌的监测等措施减少新生儿医院感染发生     

新生儿肺透明膜病医院感染的高危因素及控制对策

目的探究新生儿肺透明膜病发生医院感染的高危因素以及控制对策。方法选取我院新生儿肺透明膜病患儿324例,分析体重、胎龄、喂养方式、分娩方式、侵入性操作等因素与患儿医院感染的关系,研究病原菌种类,并对高危因素进行logistic回归分析。结果 324例患儿中发生54例院感,感染率16.67%,患儿感染部位以上呼吸道(27.78%)和肺脏(51.85%)为主,培养的54株病原菌中,革兰阳性菌15株,以葡萄球菌属为主(20.37%),革兰阴性菌37株,以肺炎克雷伯杆菌为主(37.04%),真菌2株,为白假丝酵母。多因素logistic回归分析,发现体重2500g、胎龄37周、住院时间长、剖宫产分娩、肠外营养、侵入性操作、感染前使用抗菌药物是新生儿院内感染的独立危险因素(P0.05)。结论:新生儿病房中应重点关注低体重、肠外营养、早产、剖宫产的患儿,通过减少侵入性操作、感染前预防性使用药物能有效控制院感的发生。     

小儿内科患儿医院感染危险因素分析研究

目的研究小儿内科医院感染的相关危险因素,为控制医院感染提供依据。方法回顾性分析2010年1月-2014年6月小儿内科3 063例患儿临床资料,采用单因素、多因素logistic回归分析发生医院感染的危险因素,数据采用SPSS17.0软件进行处理。结果小儿内科3 063例患儿中发生医院感染1 021例,感染率33.33%;单因素分析结果显示,小儿内科患儿住院时间>14d、有中心静脉插管、留置胃管、白血病、肺炎、恶性肿瘤等的感染率,分别为57.37%、96.43%、76.12%、58.17%、49.34%、42.60%,其与医院感染的发生存在密切相关性,差异有统计学意义(P<0.05);多因素分析结果显示,住院天数、中心静脉插管、留置胃管、白血病、肺炎及恶性肿瘤是小儿内科患儿发生医院感染的独立危险因素。结论小儿内科患儿感染与住院时间、白血病及侵入性操作等相关,针对相关因素采取相应的防护措施,以降低感染率。     

新生儿重症监护室早产儿医院感染的研究

目的探讨新生儿重症监护室早产儿医院感染的发生情况及其危险因素,为医院感染的预防控制提供依据。方法选取2014年1月-2015年12月医院新生儿重症监护室收治的438例早产儿作为临床研究对象,并对其临床资料予以回顾性分析。结果新生儿重症监护室438例早产儿中发生医院感染49例,感染率为11.19%;新生儿重症监护室早产儿医院感染基础疾病以新生儿肺炎和呼吸窘迫综合征为主,分别占44.90%和36.73%;新生儿重症监护室早产儿医院感染部位以呼吸道和皮肤为主,分别占40.82%和22.45%;感染患儿共检出病原菌46株,其中革兰阴性菌24株占52.17%,革兰阳性菌16株,占34.78%,真菌6株占13.04%;胎龄≤32周、出生体质量≤1 500g、机械通气>72h、胃肠外营养>7d、留置胃管、应用抗菌药物、喂养不耐受、住院天数>14d是新生儿重症监护室早产儿发生医院感染的危险因素(P<0.05),经logistic多因素回归分析,机械通气>72h、出生体质量≤1 500g、胎龄<32周、胃肠外营养是早产儿发生医院感染的独立危险因素。结论导致新生儿重症监护室早产儿发生医院感染的危险因素相对较多,发生医院感染的患儿其基础疾病以新生儿肺炎和呼吸窘迫综合征为主,肺炎克雷伯菌和金黄色葡萄球菌为引起医院感染的主要致病菌,加强对早产儿医院感染管理,合理化应用抗菌药物,对于降低早产儿医院感染具有重要意义。     

肾病科患者医院感染危险因素分析

目的探索肾病科医院感染的相关危险因素及病原菌分布,为控制感染提供依据。方法对2010年1月-2014年6月肾病科11 389例患者的临床资料进行回顾性调查,应用单因素分析和多因素logistic回归分析对感染危险因素进行分析,采用SPSS17.0软件对数据进行统计分析。结果肾病科11 389例患者发生医院感染344例、391例次,感染率3.02%、例次感染率3.43%;感染部位以下呼吸道感染为主,占43.99%;共检出病原菌309株,革兰阴性菌136株占44.02%,革兰阳性菌84株占27.18%,真菌89株占28.80%;单因素分析显示,体质量较低、介入史、年龄偏高、高血压、糖尿病、尿毒症、慢性肾功能不全、肾病综合征、总住院天数、入住ICU、中心静脉置管、使用呼吸机及留置尿管等与医院感染的发生存在密切的相关性(P<0.05);多因素logistic回归分析结果显示,体质量较低、入住ICU、住院时间长、患有高血压、肾病综合征、使用呼吸机、中心静脉置管及留置尿管是医院感染发生的独立危险因素(P<0.05)。结论在临床工作中,针对危险因素采取相应控制措施,以预防与控制医院感染的发生。     

新生儿肺炎感染现状和危险因素分析

目的探讨新生儿肺炎感染现状及其危险因素。方法选择2017-2019年杭州市妇产科医院收治的47例新生儿肺炎患儿为观察组,并选择同期未感染的新生儿50例为对照组,回顾性分析新生儿肺炎感染的危险因素,计算和总结其出生季节及病毒感染情况,总结新生儿肺炎感染的现状,观察其临床表现。结果出生季节和病毒感染情况:新生儿肺炎患儿72.34%出生于春冬季节;48.94%患儿感染肺炎克雷伯菌,31.91%患儿感染金黄色葡萄球菌,19.15%患儿感染大肠埃希菌;临床表现:肺炎新生儿大都表现为呼吸困难、呻吟、发绀和青紫、低体温、昏迷、抽搐、呼吸及循环衰竭等症状。单因素分析结果显示:是否早产、是否侵袭性操作、是否预防抗生素、住院时间、出生季节及新生儿体质量与新生儿肺炎感染有关;多因素Logistic回归分析结果显示:是否早产、是否侵袭性操作、是否预防抗生素、住院时间以及新生儿体质量是新生儿感染肺炎的独立危险因素。结论新生儿肺炎感染常见于春冬季节出生的新生儿以及低体质量和接受过侵袭性操作与未预防抗生素、住院时间长的新生儿,且多数患儿感染病菌为肺炎克雷伯菌、金黄色葡萄球菌和大肠埃希菌,患儿发病后均表现为呼吸困难、呻吟、发绀及青紫等症状。     

新生儿病房医院感染临床调查与危险因素分析

目的探讨新生儿病房医院感染发生的高危因素,为降低感染率制定相应预防措施提供依据。方法回顾性分析2013年6月-2015年1月医院收治的6 827例新生儿临床资料,分析85例发生医院感染新生儿的高危因素,数据采用SPSS 19.0软件进行统计分析。结果 6 827例住院新生儿中,发生医院感染85例,感染率为1.2%;85例医院感染新生儿中共分离出38株病原菌,以革兰阴性菌为主,共27株占71.0%;多因素分析显示,出生体质量≤1500g、住院时间≥9d、胎龄<37周、气管插管、PICC置管是导致新生儿发生医院感染的独立危险因素(P<0.05)。结论新生儿医院感染主要病原菌为革兰阴性菌,临床上需要针对医院感染的危险因素制定相应的预防措施,从而降低医院感染率。     

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.