恶性肿瘤病例医院感染影响因素的分析

目的 :了解恶性肿瘤病人的医院感染影响因素 ,为加强医院感染管理提供依据。方法 :收集某医院 2 0 0 0年所有恶性肿瘤住院病例资料 ,按 1∶ 2配比进行病例对照研究。对有关可能的因素进行条件 logistic单因素及多因素回归分析。结果 :单因素条件 logistic回归分析筛选出住院天数 ,肿瘤转移、化学疗法、放射疗法、合并糖尿病、动静脉插管、气管切开、手术、应用抗生素等 9个因素与肿瘤患者的医院感染有关 (除手术 P<0 .0 5外 ,P均 <0 .0 1)。多因素条件 logistic回归分析筛选出住院天数、化学疗法、放射疗法、合并糖尿病、应用抗生素 (P均 <0 .0 1)及动静脉插管 (P<0 .0 5 )与医院感染有关 ,其中抗生素的应用为负相关。结论 :合理使用现代化学、放射医疗技术及抗生素可减少和预防恶性肿瘤病人医院感染的发生。伴有糖尿病的恶性肿瘤患者医院感染发生的危险性增大     

医院感染危险因素调查分析

目的 分析住院患者医院感染的危险因素,为临床科室的医院感染预防与控制提供依据.方法 回顾性分析327例住院患者医院感染的临床资料.结果 327例患者中,呼吸道感染居首位,占56.27％,其次为消化道感染,占18.96％,泌尿道、皮肤切口、血液感染分别占8.87％、5.20％、4.89％;经单因素logistic回归分析后,年龄、住院时间、使用抗菌药物、泌尿道插管、气管插管、抗肿瘤治疗、恶性肿瘤、腹腔穿刺引流、使用呼吸机、免疫抑制剂或激素、抗真菌药物的使用、白细胞数和基础疾病等因素,差异均有统计学意义(P＜0.05);多因素logistic回归分析后发现,年龄、住院时间、泌尿道插管、气管插管、恶性肿瘤、白细胞数和免疫抑制剂或激素的使用与医院感染的发生显著关联.结论 医院感染与患者高龄、住院时间长等多因素有关,必须加强对易感因素的预防和控制,减少医院感染的发生.     

肿瘤病人术后医院感染危险因素病例对照研究

目的探讨消化道恶性肿瘤病人医院感染危险因素。方法收集某综合性医院2001年消化道恶性肿瘤住院病例,按1∶2配对进行病例对照研究,对暴露因素进行单因素及多因素条件Logistic回归分析。结果单因素条件Logistic回归分析筛选出累计病程、入院时并存感染、住院总天数、感染前应用抗生素累计天数、护理级别、应用抗生素目的等22个关联因素。多因素条件Logistic回归分析筛选出医院感染前应用抗生素(无并存感染)、住院总天数≥28d、切口类型、术后并发症等4个危险因素。结论医院感染前应用抗生素(无并存感染)、住院时间≥28d、切口污染、术后有并发症的消化道恶性肿瘤患者发生医院感染的危险性增大;尤其是术后有并发症的患者发生医院感染的危险性更大。     

医院败血症相关危险因素及耐药性分析

目的探讨医院败血症的危险因素,减少医源性因素所致败血症风险。方法收集2006年1月至2009年12月期间在本院住院的菌血症患者资料。根据医院感染的定义将这些患者分为医院败血症组（83例）和社区获得性败血症组（119例）,对2组临床资料进行统计,对筛选出的可能危险因素进行多因素logistic回归分析。结果与社区获得性败血症相比较,医院败血症患者患恶性肿瘤的比例较高（21／83VS12／119,x2：8．2846,P〈0．01）,使用静脉留置导管比例高（28／83VS3／119,）（。=36．67,P〈0．01）,接受手术者比例高（37／83VS0／119,x2=68．226,P〈0．01）,既往使用抗生素比例较高（78／83VS10／119,x2=173．5657,P〈0．01）。多因素logistic回归分析示：伴有糖尿病者（P〈0．001,OR=4．821）、患恶性肿瘤者（P〈0．05,OR=3．186）、有静脉留置导管者（P〈0．05,OR=2．135）及既往不当抗生素治疗者（P〈0．05,OR=2．135）更易患医院败血症。且医院败血症感染细菌耐药率更高。结论医院内败血症严重威胁人类健康,糖尿病、恶性肿瘤、静脉留置导管及抗生素不当使用是相关危险因素。且医院内败血症感染细菌更具耐药性。     

Logistic回归分析恶性肿瘤患者并发医院感染的特点

目的探讨恶性肿瘤患者并发医院感染的特点及其危险因素。方法回顾性分析210例恶性肿瘤并发医院感染的患者的临床资料,对可能与恶性肿瘤并发医院感染有关的因素进行非条件Logistic回归分析。结果恶性肿瘤患者医院感染率高于其他疾病患者(P<0.05),且并发医院感染以肺癌病人为主。常见的感染部位为呼吸道、泌尿道和胃肠道,病原菌以革兰阴性杆菌为主(56.3%)其中以大肠埃希菌、铜绿假单胞菌及肺炎杆菌为主。多因素非条件Logis-tic回归分析筛选出住院的时间、介入性操作、抗生素的应用、化疗、手术、合并糖尿病及肿瘤转移是医院感染的危险因素(P<0.05)。结论为了预防恶性肿瘤患者发生医院感染,应采取的主要措施是缩短住院时间、合理使用抗生素、尽量避免化疗导致的白细胞下降、减少不必要的介入性操作、严格的控制原发病。     

腹部恶性肿瘤术后医院感染危险因素Logistic回归分析

目的调查分析腹部恶性肿瘤患者术后医院感染的危险因素,以制定预防和控制医院感染的方案。方法回顾性对照分析2007年3月~2009年3月医院腹部恶性肿瘤术后感染与非感染患者病例,包括:性别、年龄、是否患有糖尿病、术前住院天数、麻醉ASA分级、手术时间、引流管数量、是否有中央静脉插管、术后住院天数等,并采用SPSS软件包进行Logistic回归方法统计。结果Logistic回归分析显示,患糖尿病、手术时间≥230 min、术前住院时间≥6 d、麻醉ASA≥Ⅲ级4个变量与术后医院感染的相关性差异有统计学意义。结论结果中的4个变量均是术后医院感染的危险因素,术后医院感染增加了患者的术后住院时间。     

恶性肿瘤患者医院感染影响因素分析研究

目的研讨恶性肿瘤患者医院感染的影响因素及针对性的对策,为降低感染率提供参考依据。方法调查2013年12月-2015年6月医院诊治的1 000例恶性肿瘤患者临床资料,分析发生医院感染的影响因素,对恶性肿瘤患者医院感染进行非条件logistic分析,数据采用SPSS 18.0软件进行统计分析。结果 1 000例患者中有232例发生感染,感染率为23.2%;共检出276株病原菌,以痰液检出为主,共165株占59.8%;232例感染患者中以呼吸道感染为主,共122例占52.6%;logistic分析结果显示,年龄、住院天数、放射疗法、合并糖尿病、抗菌药物使用以及动静脉插管是发生感染的独立危险因素(P0.05)。结论恶性肿瘤患者医院感染率较高,应该加强患者生命体征检测,合理使用现代医疗技术和抗菌药物降低医院感染发生率。     

某医院围手术期医院感染情况及其影响因素分析

[目的]了解围手术期病人医院感染的发病情况，分析其影响因素。[方法]观察2002年济南铁路局中心医院所有手术患者的感染情况，并对影响发病的可能因素进行非条件Logistic回归分析。[结果]1368例患者，从人院至手术后出院发生医院感染192例，感染率为14．04％。感染率，男性13．92％，女性14．21％。不同年龄，手术持续时间不同，住院时间不同，使用抗生素的种类不同、时间长短不同，麻醉方式不同，是否伴有恶性肿瘤、糖尿病，是否气管切开，手术切口分类不同的病人，其医院感染率不同（P〈0．01）。非条件Logistic回归分析结果，年龄、手术持续时间、麻醉方式、伴发恶性肿瘤、住院时间进入回归方程。[结论]年龄大、手术持续时间长、全身麻醉、伴发恶性肿瘤、住院时间长是病人发生围手术期医院感染的危险因素。     

前瞻性调查与医院感染危险因素的病例对照分析

目的明确医院感染危险因素,评估和指导临床科室的医院感染预防与控制工作,并为目标性监测提供依据。方法对2007~2008年开展的前瞻性调查与医院感染病例回顾性调查所得资料进行筛选,采用1∶2病例对照研究方法,对医院感染相关因素进行单因素和多因素Logistic回归分析。结果通过对352例病例和709例对照病例的分析,医院感染部位发生率较高的为下呼吸道(42.60%)、上呼吸道(27.84%)、泌尿道(12.50%);医院感染病例主要发生在内科病房(64.20%);在单因素分析中科室、年龄、住院天数、泌尿道插管、使用呼吸机、动静脉插管、使用免疫抑制剂或激素、慢性病、恶性肿瘤、气管切开或插管以及腹腔穿刺引流等11项因素差异有统计学意义(P0.05);多元素分析显示科室、住院天数、泌尿道插管、动静脉插管、慢性病、气管切开或插管和腹腔穿刺引流等7项因素,其中泌尿道插管、动静脉插管和腹腔穿刺引流3项呈负相关(OR1)。结论医院感染的发生主要与慢性病、泌尿道插管、动静脉插管、气管切开或插管和腹腔穿刺引流等有关,需加强内科病房以及慢性病患者的预防与控制措施,尽量减少患者住院时间,对各类插管患者继续执行有效诊疗措施。     

糖尿病住院患者医院感染危险因素对照研究

目的探讨糖尿病住院患者合并医院感染的危险因素。方法回顾性分析1620例糖尿病患者住院病历,将合并医院感染者作为观察组,按1∶2选择同期无医院感染糖尿病患者作为对照组,对感染可能因素先进行单因素分析,将有显著意义的因素赋值后进行多因素非条件logistic分析。结果医院感染发生率为8.64%;单因素分析9个变量是医院感染危险因素,logistic回归分析结果筛选出高龄、侵入性操作、血糖水平高、预防性应用抗菌药物是独立危险因素。结论糖尿病住院患者医院感染发生率较高,影响因素较多,应密切监测高龄患者;减少侵入性操作,控制血糖水平,合理应用抗菌药物,降低医院感染的发生。     

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.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

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.