230例死亡病历医院感染的分析

目的了解死亡患者医院感染的基本情况,探讨死亡原因与感染的关系. 方法对我院2002年度死亡病历共 230份,采取回顾性的调查分析. 结果 230例死亡病历中有医院感染72例 125例次,医院感染率为31.3%,是同期医院感染的9.74倍;47.39%的死亡与感染有关;72例有医院感染的死亡病例平均住院56.4d,比全院平均住院日(17.3d)多39.1d;死亡病历中≥两种基础疾病 204例;各种恶性肿瘤 103例,占死亡总数的44.78%;呼吸系统感染占医院感染的首位;在送检的各类标本中检出G-菌37株,G 菌25株,真菌22株. 结论医院感染是加速和导致患者死亡的重要原因;各种恶性肿瘤患者是医院感染的主要人群;呼吸系统感染是预防的重点;G-菌为医院感染的主要致病菌.     

老年恶性肿瘤死亡病例与医院感染

目的 了解老年恶性肿瘤死亡病例医院感染的情况。方法 回顾性调查分析近年来我科住院的老年恶性肿瘤死亡病例186例，了解医院感染的发生率，医院感染与既往治疗及住院日的关系。结果 既往曾行过放疗和化疗的患者，其医院感染的发生率明显高于未行过放疗、化疗者；住院时间的长短与医院感染发生率密切相关。结论 缩短平均住院日，加强对放、化疗后的患者的支持治疗有利于减少医院感染发生率。     

妇科肿瘤患者医院感染的相关因素分析

目的 研究妇科肿瘤患者放疗后发生医院感染的相关因素,为临床治疗及预防提供参考依据。方法 回顾性分析2013年3月-2014年3月妇科508例肿瘤放疗患者临床资料,分析发生感染患者的相关因素,所有数据采用SPSS 19.0软件进行统计分析。结果 共42例患者发生医院感染,感染率为8.27%;感染部位以泌尿道为主,共14例占33.34%;共检出42株病原菌,其中革兰阴性菌17株占40.48%、革兰阳性菌22株占52.38%、真菌3株占7.14%;粒细胞减少、糖尿病、接受侵入性操作为患者发生感染的相关因素(P<0.05)。结论 妇科肿瘤患者放疗的医院感染率较高,患者应及时诊治,需积极预防侵入性操作、粒细胞减少及糖尿病带来的医院感染风险,有效降低医院感染发生率。     

鼻咽癌患者放疗期间医院感染发病率及影响因素

目的调查鼻咽癌住院患者放疗期间医院感染发病率及其影响因素。方法回顾性分析2012年7月—2014年6月江苏省某三级甲等肿瘤专科医院住院进行放疗的鼻咽癌患者医院感染发生情况。结果共调查1 396例接受放疗的鼻咽癌患者,医院感染发病率为2.29%,例次医院感染发病率为2.44%。医院感染部位以口腔黏膜为主（24例次,占70.59%）,多发生在放疗开始后的2～4周。共分离病原菌38株,其中革兰阳性菌24株（占63.16%）,革兰阴性菌12株（占31.58%）,真菌2株（占5.26%）。年龄＞50岁、合并化疗、住院时间＞60 d、使用2种及以上抗菌药物的鼻咽癌放疗患者的医院感染发病率高（均P＜0.05）。结论应加强鼻咽癌放疗患者医院感染的预防与控制,尤其是对于高龄、合并化疗、住院时间长及抗菌药物广泛使用的患者。     

肿瘤患者合并医院感染调查分析

目的 调查肿瘤科患者合并医院感染的特征,探讨其相应对策.方法 回顾性调查1280例肿瘤患者的临床资料.结果 1280例肿瘤患者合并医院感染260例,感染率为20.3％;以呼吸系统为主共105例;送标本培养240份,检出病原菌110株,阳性率为45.8％;其中革兰阴性菌50株占45.4％,革兰阳性菌40株占36.4％,真菌20株占18.2％年龄大、化疗次数多、预防应用抗菌药物、侵入性操作、住院时间长是医院感染的危险因素;感染组死亡率为15.4％.结论 肿瘤科患者医院感染可加重病情,应提高高龄患者机体免疫力;掌握抗菌药物适应证;严格遵守无菌操作;缩短住院日创造条件以减少医院感染的发生.     

肿瘤化疗后粒缺状态患者医院感染及对策

目的：了解肿瘤化疗后粒细胞缺乏状态患者并发医院感染发生率、易感因素及处理对策。方法及结果：分析了5年来177例肿瘤（其中主要为血液系肿瘤）患者。共发生粒缺359例次,并发医院感染221次（61.56%）,其中败血症61次,肺部及上呼吸道感染74次,口腔、咽部感染38次。共分离出细菌87株,G^-杆菌52株（占59.77%）,其中大肠杆菌24株;G^ 球菌24株（占28.74%）,其中金葡菌15株;真菌10例次。死亡35例（19.77%）。结论：长期住院、患者处于非无菌环境下、粒细胞缺乏持续时间长是并发感染的主要因素。认为无菌病房的建立、缩短粒缺持续时间,是预防感染的主要手段。     

放疗加紫杉醇治疗晚期鼻咽癌患者医院感染的临床分析

目的调查分析晚期鼻咽癌患者常规放疗同时行紫杉醇化疗过程中并发医院感染及相关因素,探讨有效的防治措施。方法对我院26例行放疗同时紫杉醇化疗鼻咽癌住院患者发生医院感染及危险因素进行回顾性分析。结果26例住院患者发生医院感染20例,占76.9%;检出致病菌26株,其中以白色念珠菌为主,占46.2%,革兰阴性菌占38.5%,革兰阳性菌占11.5%;鼻咽癌放疗、化疗同步治疗并发医院感染与长期住院、口腔黏膜损伤、白细胞下降、不合理应用抗生素和糖皮质激素等因素有关。结论缩短平均住院日、加强口腔护理、预防白细胞下降、合理应用抗生素和糖皮质激素,以减少鼻咽癌同步放化疗患者医院感染的发生率。     

老年肿瘤患者医院感染调查分析

目的探讨2008-2013年医院老年肿瘤患者医院感染的病原菌分布,为临床诊治提供参考。方法回顾性分析2008年12月-2013年1月在医院治疗的1 684例老年肿瘤患者,对其中出现医院感染的患者进行病原菌分布调查。结果 1 684例老年肿瘤患者发生医院感染111例,感染率为6.59%;感染部位以下呼吸道感染最常见,51例占46.0%;共分离病原菌123株,其中革兰阴性菌78株占63.4%,以大肠埃希菌为主;革兰阳性菌31株占25.2%,以金黄色葡萄球菌为主;真菌14株占11.4%;抗菌药物使用率为54.9%,其中放疗和手术以预防性抗菌药物使用普遍,而化疗则以治疗性使用抗菌药物常见,在抗菌药物的联合应用上,放疗、化疗以一联使用为主,而手术则以二联使用为主,总体上仍以一联用药为主。结论老年肿瘤患者医院感染以下呼吸道感染为主,病原菌以大肠埃希菌、金黄色葡萄球菌、白色假丝酵母菌为主,要加强对抗菌药物的应用管理。     

肿瘤化疗患者医院感染的危险因素分析

目的研究肿瘤化疗患者医院感染病原菌的耐药性以及感染因素,指导控制和治疗肿瘤化疗患者医院感染。方法选取2011年3月-2012年12月进行化疗的肿瘤患者685例,记录发生感染患者的病例数;对感染患者送检标本进行分离培养病原菌;采用K-B琼脂试验检测病原菌的耐药性,并研究感染的危险因素。结果 685例肿瘤化疗患者发生医院感染75例,感染率10.95%;感染部位以呼吸道为主占53.33%,其次为消化道、泌尿道、生殖道及皮肤感染,分别占17.34%、12.00%、8.00%及5.33%;共分离出病原菌82株,其中革兰阳性菌36株占43.90%,革兰阴性菌39株占47.56%,真菌7株占8.54%;革兰阳性菌对利奈唑胺、革兰阴性菌对美罗培南、真菌对制菌霉素的耐药率均为0;肿瘤患者发生医院感染的危险因素为患者年龄大、化疗时间长、合并其他疾病、进行侵入性操作、未应用抗菌药物预防。结论肿瘤化疗患者是医院感染的高危人群,医护工作人员应采取措施控制化疗患者医院感染的发生,选用耐药率低的抗菌药物进行及时治疗。     

成人急性白血病医院感染危险因素及对策

目的：为了进一步研究导致成人急性白血病患者发生医院感染的危险因素,从而为临床实践提供借鉴和参考。方法：本文以本院2011年12月-2013年1月期间入院治疗的466例成人急性白血病患者为研究对象,针对患者的临床资料进行回顾性分析。结果：本次调查的成人急性白血病医院感染发生率为30.04%;大于或等于60岁患者的感染率（47.22%）显著地高于小于60岁的患者（15.20%）;实施化疗患者的感染率（33.59%）显著地高于未实施化疗的患者（10.00%）;住院时间大于30d患者的感染率（51.65%）显著地高于住院时间小于15d（6.12%）和15～30d（31.41%）的患者,差异均具有统计学意义（P〈0.05）。结论：患者的年龄、实施化疗情况、住院时间是导致急性白血病医院感染的危险因素。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.