自由体位干预在无痛分娩中的应用及对母婴结局的影响

目的 探讨自由体位干预在无痛分娩中的应用及对母婴结局的影响。方法 回顾性选取2019年10月-2021年4月于广东省阳江市妇幼保健院进行分娩的120例产妇,根据分娩体位不同分为对照组和观察组,各60例。对照组采用传统体位无痛分娩,观察组采用自由体位无痛分娩,观察两组产妇的总产程时间及最终分娩方式。观察两组产妇发生产后出血、会阴侧切、会阴水肿及宫颈裂伤情况。采用疼痛视觉模拟评分量表（VAS）、爱丁堡产后抑郁量表（EPDS）分别评估两组产妇分娩时自感疼痛程度及产后心理状态;采用新生儿Apgar量表评估新生儿窒息情况。结果 观察组总产程时间明显短于对照组（P<0.05）。观察组产程中转剖宫产发生率、阴道助产率、产妇产后出血、会阴侧切、会阴水肿及宫颈裂伤发生率均显著低于对照组（P<0.05）。观察组产妇分娩过程中VAS及产后EPDS评分均明显优于对照组（P<0.05）。观察组新生儿Apgar量表评分高于对照组,差异具有统计学意义（P<0.05）。结论 自由体位干预应用于无痛分娩中可缩短产程,降低转剖宫产、阴道助产发生率,减轻疼痛且缓解抑郁,有效改善母婴结局。     

无保护会阴接生法在提高初产妇自然分娩率及促进产程中的作用

目的探讨无保护会阴接生法在提高产妇自然分娩率及促进产程的作用。方法选取600例在医院行自然分娩的初产妇随机分为观察组和对照组各300例,对照组采用传统接生技术实施分娩,观察组采用无保护会阴接生法实施分娩,比较两组产妇自然分娩率、中转剖宫产率、阴侧切率、会阴完整率、会阴侧切、会阴裂伤、会阴水肿、会阴疼痛、分娩产程及新生并发症情况。结果观察组产妇自然分娩率、会阴完整率高于对照组,而中转剖宫产率、会阴侧切率、会阴切口感染率低于对照组,会阴裂伤程度、会阴水肿程度、会阴疼痛程度较对照组轻,差异均有统计学意义(P0.05)。观察组第二产程短于对照组,产后2 h失血量少于对照组,产后出血率、软产道裂伤、新生儿锁骨骨折、新生儿窒息等不良妊娠结局发生率低于对照组,差异均有统计学意义(P0.05)。结论无保护会阴接生法能有效降低初产妇会阴侧切率,减轻产妇会阴损伤程度,缩短产妇第二产程,减轻产妇分娩痛苦及提高产妇舒适性,降低产妇及新生儿不良分娩结局,且该方法操作简单、安全、有效,值得临床推广应用。     

自由体位分娩对初产妇分娩结局的影响研究

目的研究自由体位分娩对初产妇分娩结局影响。方法选取2015年5月至2017年6月西安市第四医院产科接收的初产妇2 860例,按照随机数字表法平均分为两组,剔除分娩过程中使用催产药物和试产失败产妇,自由体位分娩组1 420例,常规体位分娩组1 419例。观察两组产妇分娩过程中各产程时间、阴道出血量、产时疼痛、分娩控制感、会阴裂伤及侧切情况,统计两组产钳助产率、中转剖宫产率以及新生儿Apgar评分。结果自由体位分娩组第一产程时间、第二产程时间及总产程时间均明显短于常规体位分娩组,差异有统计学意义(P0.05)。自由体位分娩组产妇视觉模拟量表(visual analogue scale,VAS)、语言反应量表(verbal rating scale,VRS)、现实疼痛强度量表(present pain intensity,PPI)评分低于常规体位分娩组,分娩控制量表(labour agentry scale,LAS)评分高于常规体位分娩组,产后出血、会阴裂伤、产钳助产、会阴侧切、中转剖宫产的发生率低于常规分娩体位组,自由体位分娩组新生儿Apgar评分为0~3分的少于常规体位分娩组,而8~10分多于常规体位分娩组,差异均有统计学意义(P0.05)。结论自由体位对于初产妇效果理想,有助于改善分娩结局,降低应激反应,缩短产程时间,值得临床推广应用。     

自由体位联合会阴无保护接生技术在第二产程中的应用

目的探讨自由体位联合会阴无保护接生技术在自然分娩第二产程中的应用效果。方法选择郑州大学第三附属医院2015年采用会阴无保护接生技术分娩的360例初产妇作为观察组,其第二产程中可采用站立、蹲、半坐、侧卧位等自由体位分娩,同期360例初产妇作为对照组,在第二产程中采用传统的膀胱截石位,并给予托肛保护会阴接生。比较两组产妇的会阴侧切率、会阴裂伤情况、第二产程时间、产后2 h出血量、患者满意度及分娩不良结局等。结果与对照组相比,观察组的第二产程时间较短,会阴完整率和患者满意度均较高(P0.05);观察组会阴侧切率、裂伤程度均明显低于对照组(P0.05);两组对象的产后2 h出血量、新生儿窒息率、肩难产发生率、会阴水肿程度差异均无统计学意义(P0.05)。结论自由体位联合会阴无保护接生技术,可以有效的缩短第二产程,降低会阴侧切率,减少会阴裂伤,提高患者满意度,且不增加产后2 h出血量、新生儿窒息率及肩难产的发生,更有利于自然分娩,值得临床推广。     

低危初产妇第一产程采用自由体位对分娩及产程的影响

目的探讨低危初产妇第一产程采取自由体位对分娩及产程的影响,分析自由体位在分娩过程中的临床应用价值。方法选取2015年7月-2016年7月在该院住院分娩的初产妇400例,按照随机抽样法将400例产妇平均分为观察组和对照组,其中对照组采用传统仰卧位,观察组采取自由体位,对比两组初产妇产后疼痛程度、活跃期时间、第一产程时间、阴道分娩率、剖宫产率、阴道助产率以及医疗干预情况。结果在产后疼痛对比中,观察组产妇术后6、12以及24 h VAS疼痛评分均明显低于对照组(P0.05),而两组产妇术后1 h VAS疼痛评分无明显差异(P0.05);观察组产妇的活跃期为(3.47±0.29)h,明显短于对照组产妇的(4.18±0.58)h(P0.05);观察组产妇的第一产程时间为(8.14±2.11)h,明显短于对照组的(12.05±3.79)h(P0.05)。此外,观察组产妇的阴道分娩率、剖宫产率以及阴道助产率分别为92.00%、2.00%、1.00%,对照组产妇的阴道分娩率、剖宫产率以及阴道助产率分别是85.00%、10.00%和5.00%,两组比较差异有统计学意义(P0.05);观察组产妇使用缩宫素以及会阴侧切的发生率明显低于对照组(P0.05)。结论低危初产妇可在第一产程中采取自由体位,不仅减轻痛苦,缩短产程时间,同时能够显著提高阴道分娩率,降低剖宫产率,同时也减少了药物干预和会阴侧切的发生率。     

第二产程行自由体位对产妇妊娠结局的影响

目的探讨第二产程行自由体位对产妇妊娠结局的影响。方法选取2018年1月-2019年1月在深圳市宝安区松岗人民医院分娩的产妇450例,其中225例孕期条件许可、且自愿在第二产程行自由体位为观察组;另选取225例第二产程行膀胱截石位产妇为对照组。比较两组产妇第二产程时间、疼痛情况、产后出血情况、产妇阴道助产及转剖宫产率、会阴侧切率和新生儿并发症发生情况。结果观察组产妇第二产程时间短于对照组,且观察组NPRS评分、产后2h出血量和24h出血量均低于对照组;观察组会阴侧切率为4.89%,明显低于对照组的17.33%;观察组新生儿并发症发生率为2.22%,低于对照组的11.11%,差异均有统计学意义(P0.05)。结论产妇第二产程行自由体位可以缩短第二产程时间,减轻患者疼痛,减少会阴损伤以及产后出血量,降低新生儿并发症发生率,值得临床推广应用。     

自由体位联合硬膜外复合脉冲式镇痛泵对初产妇镇痛及分娩影响

目的:分析自由体位联合硬膜外复合脉冲式镇痛泵对初产妇疼痛强度评分(PPI)、产程及中转剖宫产率的影响。方法:选取2015年3月-2019年5月本院分娩的240例产妇,随机分为观察组与对照组,两组产妇均采用硬膜外复合脉冲式镇痛泵镇痛,对照组采用传统平卧位分娩,观察组采用自由体位分娩,比较两组产妇分娩及新生儿情况。结果:观察组阴道自然分娩率(90.0%)高于对照组,阴道助产(1.7%)及中转剖宫产率(8.3%)低于对照组,第二产程(37.2±10.3min)短于对照组短,产妇Ⅱ度会阴裂伤发生率(3.3%)低于对照组(均P0.05)。新生儿出生后1 min Apgar评分观察组(9.4±0.4分)高于对照组(均P0.05),出生后5 min Apgar评分两组无差异(P0.05)。T0时刻及T2-T5时刻产妇PPI评分观察组均低于对照组,观察组产妇麻醉用药量及PCA次数均低于对照组(均P0.05)。分娩期间无瘙痒、恶心、低血压等不良反应发生。结论:自由体位联合硬膜外复合脉冲式镇痛泵有助于减轻分娩疼痛,缩短产程,促进自然分娩。     

分析自由体位分娩方法在提升自然分娩率和降低剖宫产率中的作用

目的:对自由体位分娩方法在提高自然分娩率、降低剖宫产率中的作用效果进行探究。方法:按照抽样原则对我院2018年4月~2019年4月期间的产妇进行研究,共176例,根据不同体位分娩法分为甲组、乙组,均88例,甲组采取常规体位分娩法,乙组采取自由体位分娩法,比较两组分娩结局、总产程时间、会阴侧切率等效果,综合评价自由体位分娩方法的临床价值及推广意义。结果:乙组总产程时间短于甲组,比较差异有显著性(P>0.045);乙组自然分娩率(93.18%)高于甲组(63.64%),但剖宫产率(6.82%)低于甲组(36.36%),对比差异有显著性(P<0.05);乙组会阴侧切率(2.27%)明显高于甲组(13.64%),对比差异有显著性(P<0.05)。结论:对产妇予以自由体位分娩法,可优化妊娠结局,减少会阴损伤,加速产程进展。     

自由体位分娩对自然分娩率和剖宫产率影响的临床观察

目的:观察自由体位分娩对不同分娩方式的影响。方法:选取94例来我院分娩的孕产妇为研究对象,按入院顺序将其分为两组,采取常规卧位分娩的为对照组,应用自由体位分娩的则为观察组。对比两组产妇的产程时间及分娩方式。结果:①产程时间方面,两组产妇第二、第三产程时间差异不明显(P>0.05),但观察组第一及总产程时间显著低于对照组(P<0.05)。②分娩方式方面,观察组自然分娩率要显著高于对照组,剖宫产率明显低于对照组,P<0.05。结论:通过采取自由体位的方式进行分娩,可缩短产程,降低剖宫产率。     

自由体位配合分娩球助产模式在初产妇分娩中的应用

目的 研究自由体位配合分娩球助产模式在初产妇分娩中的应用效果.方法 选取本院收治的初产妇100例,随机分为对照组与观察组,各50例.对照组对产妇进行常规产前指导,观察组在此基础上指导产妇选择自由体位,并利用分娩球助产.对比两组疼痛程度、分娩方式以及产程时间.结果与对照组相比,观察组经阴道分娩率更高,剖宫产率更低(P<0.05);对比第一产程时间与总产程时间,观察组明显短于对照组(P<0.05);对比产时疼痛程度,观察组优于对照组(P<0.05).结论 自由体位配合分娩期助产模式能减轻产妇疼痛感,并缩短产程时间,提高自然分娩率.     

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.     

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.     

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.     

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.