医院感染经济损失的病例对照配对研究

目的 分析医院感染所造成的直接经济损失。方法 采用1：1病例对照配对研究方法分析医院感染的直接经济损失和延长的住院天数，共102对。结果 医院感染经济损失为平均每例4344元；不同系统疾病的感染经济损失以神经系统疾病为最高，平均每例6542元；不同感染部位的感染经济损失以下呼吸道为最高，平均每例4956元；医院感染延长的住院天数为平均每例7．47d。结论 医院感染增加了患者的经济负担，延长了住院时间，因此，预防和控制医院感染的发生具有重大的经济效益和社会效益。     

综合医院专科重症监护病房住院患者医院感染直接经济损失研究

目的探讨综合医院专科重症监护病房(ICU)住院患者,发生医院感染所造成的直接经济损失。方法采用1∶1病例对照研究方法,分析医院感染的直接经济损失和延长的住院天数共113对。结果感染组比对照组平均每例增加医疗费57 569.51元,不同专科ICU经济损失以神经内科ICU最高,平均每例增加68 905.73元,医院感染部位不同经济损失亦不同,以导管相关性血流感染最多;医院感染延长住院天数平均每例增加18.29 d,两组间差异有统计学意义(P<0.01)。结论医院感染不但增加患者的经济负担,同时增加平均住院日,降低床位周转率,因此,应按医院感染经济损失的特点合理确定医院感染控制工作的重点和优先,充分利用现有的卫生资源,提高医院感染管理工作的社会效益和经济效益。     

医院感染经济损失的病例对照研究

本次研究采用病例对照研究的方法，调查医院感染的直接经济损失，共１３７对，病例组医疗费用为１４３６８６４元，对照组的医疗费用７４０１８０元，病例组的医疗费是对照组１．９４倍，总的经济损失为６９６６８４元，平均每例感染者多支出５０５８．２８元。不同科室中以外科医院感染经济损失最高，平均每例增加费用６８６７元。感染部位不同经济损失也不同，以血液感染增加费用最高，平均增加１０４７２元，其次为泌尿系感染及下呼吸道感染，平均增加费用分别为９４３４元和８４２９元。多部位感染比一个部位感染医疗费多，平均每例增加费用３５４．２５元。１３７例感染者中，总住院天数为４０７７天，对照组的住院天数为２６５６天，共延长住院日１４２１天，平均每例感染者延长住院日１０．３７天。作者认为只要降低医院感染率１％。就可支付医院感染监控人员的工资及进行医院感染管理或研究所需要的一切费用。     

医院感染经济损失的1：1病例对照研究

目的为准确了解医院感染所造成的经济损失。方法采用病例对照研究的方法，调查医院感染的直接经济损失，共１０１对。结果病例组的总医疗费用平均为５９８９元，对照组的总医疗费用平均为３３２７元，增加了２６１５元。不同科室中以肿瘤科医院感染经济损失最高，平均增加７３８９元；感染部位以伤口感染增加费用最高，平均增加３２３２元；多部位感染比１个部位感染医疗费用增多，平均每例增加费用１５４９元。１０１例感染者中，其平均住院天数为２６．２９天，比对照组平均住院天数１５．１５天高出１１．１４天。结论医院感染将会使患者负担加重、增加医务人员工作量、降低病床周转率、医院收入下降，故预防和控制医院感染将获得巨大的社会效益和经济效益。     

综合性医院医院感染经济损失病例对照研究

目的：为探讨某综合性医院感染造成的经济损失。方法：采用1：1病例对照的研究方法，调查78例医院感染造成的直接经济损失。结果：病例组比对照组平均增加医疗费3 342元；不同专业组经济损失以呼吸内科最高，达到了11 414元；不同感染部位经济损失以下呼吸道感染最高，达到了7 491元，多部位感染经济损失高出单部位7 645元；住院日损失病例组比对照组平均延长7.2d。结论：医院感染培养加患者经济负担，延长住院时间，同时也影响医院病床周转率。     

5种类型医院感染直接经济损失的病例对照研究

[目的]分析某医院医院感染造成的直接经济损失及其影响因素。[方法]采用1∶1配对病例对照研究方法,调查211对患者的医疗费用,计算医院感染造成的直接经济损失。[结果]病例组的平均住院总费用为19,705.82元,对照组为8672.00元,平均每例医院感染病例多支出住院费用11,033.82元(Z=-12.120,P0.001)。住院总费用的增加以药费、治疗费、材料费和化验费为主。病例组的平均住院日为33 d,对照组为16 d,平均每例医院感染病例延长住院日17 d(Z=-11.172,P0.001)。[结论]医院感染增加了患者的医疗费用,延长了患者的平均住院天数,给患者造成了巨大的经济损失。     

住院患者医院感染直接经济损失评价及危险因素

目的研究住院患者因医院感染所造成的直接经济损失、危险因素及医院感染监控的重点科室。方法采用1∶1病例对照配对方法,共调查924例患者,分析患者医院感染的直接经济损失情况;同时采用病例对照Logistic回归方法,探讨医院感染的危险因素。结果因医院感染而致的住院患者平均经济损失为7716元,是对照组的2.5倍;医院感染的经济损失因科室不同而异,ICU最高,平均每例增加52 979元;医院感染患者随着年龄的增长,感染所致的经济损失和住院日的延长有增长的趋势;入院时病情情况、住院天数、患有慢性疾病、患有恶性肿瘤、有气管切开史、呼吸机使用等为住院患者医院感染的危险因素。结论住院患者医院感染严重增加了医疗费用支出,延长了平均住院日,做好感染监控工作,可获得巨大经济效益和社会效益,住院患者医院感染的重点监控人群是老年人,重点监控科室分别是ICU、外科。     

ICU病房不同部位的经济学损失研究

目的:研究ICU病房住院患者不同部位医院感染所造成的直接经济损失。方法:采用回顾性调查和前瞻性监测的方法,调查2004年1月1日至2010年12月31日某省级医院ICU病房的住院患者,共收集病例2 060例。按条件1:1配比,发生医院感染的患者为病例组,未发生医院感染的患者为对照组,比较不同部位医院感染所增加的住院费用和住院天数的差别。结果:多部位感染所造成的经济损失中位数为168 998.33元/例,占据首位,其次为呼吸道感染所造成的经济损失中位数为48 472.17元/例,手术切口感染和泌尿道感染的经济损失中位数分别为42740.31元/例和26 324.46元/例,消化道感染的经济损失中位数最少为3 820.65元/例:多部位感染延长住院天数中位数为26天,呼吸道感染延长住院天数中位数为8天,手术切口感染和泌尿道感染延长住院天数中位数均为10天,消化道感染延长住院天数中位数为3天。结论:医院感染不同部位所造成的经济损失和延长的住院天数各不相同,按照经济损失的大小依次为多部位感染、呼吸道感染、手术切口感染、泌尿道感染和消化道感染。     

耐甲氧西林金黄色葡萄球菌感染病例对经济损失与住院日影响的对照研究

目的探讨耐甲氧西林金黄色葡萄球菌(MRSA)和甲氧西林敏感金黄色葡萄球菌(MSSA)感染造成的经济损失。方法回顾性调查2012年1月-2013年12月456例MRSA感染和250例MSSA感染患者的住院费用与住院天数,并按照1∶1匹配设立对照组,比较各组的住院费用和住院天数。结果 MRSA感染组、MSSA感染组住院费用分别增加82 694.8元和18 735.3元,延长住院天数14.1d和5.9d;ICU中MRSA感染增加费用最高,为153 344.5元,延长住院天数则以外科明显;60⁷5岁MRSA造成的直接经济损失最高,达100 208.9元,延长住院天数22d;MSSA感染造成的经济损失则以>75岁组最大,直接经济损失23 914.4元,延长住院天数6.9d。结论 MRSA感染增加患者经济负担,延长住院时间,同时也影响医院病床周转率。     

ICU老年患者医院感染经济学损失病例对照研究

目的 研究ICU老年患者医院感染所造成的直接经济损失.方法 采用回顾性调查和前瞻性监测的方法,调查2004年1月1日-2010年12月31 日某省级医院ICU的老年患者,共1152例,按条件1∶1配比,发生医院感染的患者为感染组,未发生医院感染的患者为对照组,比较两组的平均住院总费用、药费和住院天数的差异.结果 感染组住院总费用平均为91 710.67元/例,对照组住院总费用平均为32 021.51元/例;医院感染经济学损失平均为59 689.16元/例,感染组显著高于对照组(P＜0.05);感染组药费平均为48 717.45元/例,对照组药费平均为14 276.88元/例,增加的药费支出为34 440.57无/例,感染组显著高于对照组(P＜0.05);感染组住院天数平均为21.0d/例,对照组住院天数平均为7.5 d/例,每例延长住院天数13.5 d;感染组显著高于对照组(P＜0.05).结论 老年患者是医院感染的高危人群,老年患者医院感染造成的经济损失较大,应采取有效措施,降低老年患者医院感染发生率,减少医院感染经济损失.     

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.