上海市144名医用X射线工作人员10年健康动态观察

[目的]了解上海市放射工作人员的健康状况,为放射防护管理提供科学依据。[方法]选择上海市部分医院从事放射工作的144名医技人员作为暴露组,于1999-2008年连续10年对健康检查结果进行动态观察,同时选择2008年健康体检的非放射工作医务人员108名为对照组,两组的年龄（t=0．12）、工龄（f=1．95）差异无统计学意义（P〉0．05）。[结果]暴露组的白细胞、红细胞、血红蛋白、血小板10年间差异有统计学意义（P〈0．05）,暴露组的外周血象与对照组比较,白细胞差异无统计学意义（P〉0．05）,红细胞、血红蛋白、血小板差异均有统计学意义（P〈0．05或P〈0．01）,白细胞、眼晶体、皮肤指甲异常阳性率高于对照组,差异有统计学意义（P〈0．01）。[结论]长期小剂量电离辐射仍可对放射工作人员的健康造成一定损害。     

围手术期呼吸系统综合护理在老年人肝切除术后康复中的作用

目的探讨老年人肝切除术后呼吸系统并发症发生的相关因素及围手术期呼吸系统综合护理在老年人肝切除术后康复中的作用。方法回顾性分析解放军总医院349例老年人肝切除手术病例术后呼吸系统并发症发生情况，总结探讨呼吸系统综合护理的方法和效果。结果本组老年患者肝切除术后呼吸系统并发症发生率为12．61％。双变量相关分析表明，实施呼吸系统综合护理（r=-0．228，P〈0．001）、术前血清白蛋白值（r=-0．112，P=0．041）与肝切除术围手术期发生呼吸系统并发症负相关，术中失血量（r=0．171，P=0．016）、总输血量（r=0．215，P〈0．001）、手术时间（r=0．240，P〈0．001）、Child—pugh评分（r=0．204，P〈0．001）、切除方式（r=0．117，P=0．028）、术后住院天数（r=0．346，P〈0．001）与肝切除术围手术期发生呼吸系统并发症正相关。实施呼吸系统综合护理的患者术后住院时间（t=4．973，P〈0．001）和总住院时间（t=4．768，P〈0．001）显著低于未实施呼吸系统综合护理患者。结论围手术期呼吸系统综合护理可以降低老年人肝切除术后呼吸系统并发症发生率，并可缩短康复时间。     

先天性甲状腺功能减低症患儿血清神经生长因子水平的研究

【目的】探讨先天性甲状腺功能减低症（congenital hypothyroidism，CH）患儿治疗前、后血清神经生长因子（nerve growth factor，NGF）浓度的变化以及与甲状腺素的关系，以期为CH患儿的监测、治疗提供基础数据及理论依据。【方法】分别测定35例CH患儿治疗前、后血清NGF浓度（酶联免疫法）及游离三碘甲状腺原氨酸（freetriiodo thyronine，FT3）、游离甲状腺素（free thyroxine，FT4）、促甲状腺激素（thyrotropie-stimulating hormone，TSH）浓度（电化学发光法），并与性别、年龄与之相匹配的35例健康婴儿做对照。所有数据输入SPSS10．0统计软件包进行分析。【结果】①CH患儿治疗前，FT4浓度明显低于正常对照组（t=9．70，P〈0．001），TSH浓度明显高于正常对照组（t=6．27，P〈0．001），NGF浓度低于对照组（t=2．47，P〈0．05）；CH患儿经左旋甲状腺素（L-T4）治疗，甲状腺功能恢复正常后FT4、NGF浓度明显高于对照组（t=7．37及t=5．34，P〈0．001）。②CH患儿治疗后，FT4、NGF浓度均明显升高，TSH浓度降至正常水平，与治疗前比较均有非常显著统计学意义（FT4：t=17．23，P〈0．001；NGF：t=2．4]，P〈0．05；TSH：t=6．30，P〈0．001）；对照组患儿随日龄的增加，FT4、NGF浓度明显下降（t=4．61及4．81，P〈0．001）；③治疗前临床甲低组NGF浓度高于亚临床甲低组（t=2．28，P〈0．05），FT4、TSH浓度也有非常显著意义（t=12．8及6．70，P〈0．001），治疗后，两组患儿FT3、FT4、TSH、NGF浓度均无统计学意义（P〉0．05）。【结论】①甲状腺激素缺乏引起先天性甲状腺功能减低症患儿血清NGF浓度降低；②外源性的甲状腺激素可使先天性甲状腺功能减低症患儿的血清NGF浓度明显增加。     

伦敦塔测量中学生自我认识功能的探索性研究

[目的]探索伦敦塔在自我认识测验中的应用前景。[方法]立意抽样抽取昆明市两所中学的两个初二年级班,采用伦敦塔改良版（TOL—R）、STROOP测验、一般自我效能感量表、自我描述问卷Ⅱ型、Barrtt冲动性量表对其进行自我认识功能的测定。[结果]共测量174名学生,TOL-R得分与一般自我效能感呈正相关（r=0．198,P〈0．05）;TOL-R与情绪稳定性分量表呈正相关（r=0．295,P〈0．001）;TOL—R与一般学业分量表呈正相关（r=0．353,P〈O．001）;TOL-R得分与冲动性量表之间呈负相关（相关系数r=-0．185,P〈0．05）;TOL—R与Stroop阅读时间呈负相关（r=-0．185,P〈0．05）。[结论]TOL-R可以作为评价中学生自我认识功能的工具。     

围手术期呼吸系统综合护理在老年人肝切除术后康复中的作用

目的探讨老年人肝切除术后呼吸系统并发症发生的相关因素及围手术期呼吸系统综合护理在老年人肝切除术后康复中的作用。方法回顾性分析解放军总医院349例老年人肝切除手术病例术后呼吸系统并发症发生情况,总结探讨呼吸系统综合护理的方法和效果。结果本组老年患者肝切除术后呼吸系统并发症发生率为12．61％。双变量相关分析表明,实施呼吸系统综合护理（r=-0．228,P〈0．001）、术前血清白蛋白值（r=-0．112,P=0．041）与肝切除术围手术期发生呼吸系统并发症负相关,术中失血量（r=0．171,P=0．016）、总输血量（r=0．215,P〈0．001）、手术时间（r=0．240,P〈0．001）、Child—pugh评分（r=0．204,P〈0．001）、切除方式（r=0．117,P=0．028）、术后住院天数（r=0．346,P〈0．001）与肝切除术围手术期发生呼吸系统并发症正相关。实施呼吸系统综合护理的患者术后住院时间（t=4．973,P〈0．001）和总住院时间（t=4．768,P〈0．001）显著低于未实施呼吸系统综合护理患者。结论围手术期呼吸系统综合护理可以降低老年人肝切除术后呼吸系统并发症发生率,并可缩短康复时间。     

广西874名放射工作人员肝功能指标分析

[目的]探讨电离辐射及其他因素对放射工作人员肝功能水平的影响。[方法]以参加广西2010-2011年度体检的874名放射工作人员为接触组,选择同期参加体检的300名非放射工作的健康人群为对照组,对两组人群进行肝功能指标的检测,并采用单因素和多因素分析方法分析数据。[结果]接触组丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、碱性磷酸酶（ALP）、胆碱酯酶（CHE）、总蛋白（TP）、自蛋白（ALB）、总胆红素（TBIL）、直接胆红素（DBIL）的异常率与对照组比较,差别均有统计学意义（P〈0．05）。不同放射工龄组间DBIL、谷氨酰转移酶（GGT）、ALB异常率差别有统计学意义（P〈0．01）。男性放射工作人员的GGT、ALT、AST、ALP、TBIL、CHE水平均高于女性（P〈0．001）。吸烟人群的DBIL高于非吸烟人群（P〈0．01）。DBIL随年龄的增长而降低（P〈0．01）,CHE随年龄的增长而增高（P〈0．01）。GGT与放射工龄呈正相关（r=0．109,P=0．001）,TP与放射工龄呈负相关（r=-0．128,P=0．000）。[结论]肝功能异常者在长期接触电离辐射的放射工作人员中多见,且与放射工龄密切相关;吸烟、性别和年龄与肝功能也有一定关系。     

腹部择期手术患者胰岛素抵抗临床观察

目的研究外科择期手术患者胰岛素抵抗（IR）的临床意义，探讨与IR的相关因素。方法选择腹部择期手术患者14例，分别检测患者术前1天、术中（手术开始后1小时）、术后24小时血浆肿瘤坏死因子-α（TNF—α）、白介素-6（IL-6）、血糖、胰岛素水平，利用稳态模式评估法（HOMA）计算胰岛素抵抗指数（HOMA—IR）、胰岛素分泌指数和胰岛素敏感指数（ISI）。结果术后血糖、胰岛素、IL-6、TNF-α水平较术前、术中均显著升高（P〈0．001），术中IL-6水平亦显著高于术前（P=0．017），而术前与术中的血糖、血胰岛素、TNF-α水平差异无显著性（分别P=0．421，P=0．116，P=0．076）。术后HOMA-IR显著高于术前（P〈0．001）。ISI与手术时间（r=-0．936、P〈0．001）、术中出血量（r=-0．594、P=0．032）、术后TNF—α水平（r=-0．641、P=0．018）呈显著负相关。结论腹部择期手术患者存在IR。缩短手术时间、降低手术创伤强度、减少出血对减轻IR具有重要意义。     

改良式小鼠颈透视下插管滴定脂多糖制备急性肺损伤模型的研究

目的探索一种损伤小、可靠、高效的小鼠气管内插管方法并滴定脂多糖制备急性肺损伤模型。方法80只BALB／C小鼠按随机数字表法分为两组：脂多糖组（LPS组）和对照组（Ns组）。气管内插管成功后分别滴定脂多糖（3mg／kg）和生理盐水（1．5ml／kg）,记录插管一次成功率、最终成功率、存活率。24h后计数左肺肺泡灌洗液（BALF）中总细胞数,瑞氏染色进行细胞分类计数,BCA法测定总蛋白浓度,肺组织烘干后计算湿／于比,动脉血气分析测定血氧分压（PaO2）并计算氧合指数。结果改良式颈透视下插管一次成功率92．5％、最终成功率和存活率均为100％;LPS组BALF中总细胞数[（10．82±3．51）×105／mlVS（0．72±0．52）×105／ml,t=-6．294,P〈0．01]、多形核粒细胞占总细胞数比例[（93．93±1．77）％VS（2．2±0．91）％,t=-105．565,P〈0．01]、单个核粒细胞占总细胞数比例[（6．07±1．77）％vs（97．8±0．91）％,t=-105．565,P〈0．01]、总蛋白浓度[（0．49±0．13）mg／mlVS（0．29±0．11）mg／ml,t=-2．823,P〈0．05]、湿／干比值（4．60±0．18VS4．16±0．25,t=-4．793,P〈0．01）、动脉PaO2【（68．57±7．23）％VS（87．00±6．33）％,t=4．571,P〈0．01]和氧合指数[（326．53±34．43）mmHgVS（414．29±30．16）mmHg,t=4．571,P〈0．01]与NS组比较差异均有统计学意义。结论改良式小鼠颈透视下气管内插管成功率高、损伤小,且滴定LPS3mg／kg成功制备了急性肺损伤模型。     

有氧运动对代谢综合征患者的疗效观察及其机制研究

目的观察长期规律有氧运动对代谢综合征（MS）患者血清瘦素、白介素-18（IL-18）、C反应蛋白（CRP）、可溶性细胞间黏附因子-1（sICAM-1）及胰岛素抵抗指数（HOMA—IR）的影响,并初步探讨有氧运动的作用机制。方法入选40例平时缺乏运动的MS患者,分层随机抽样法分为运动干预组及非诺贝特组,运动干预组进行无氧阈心率水平运动,5次／周,30min/次;非诺贝特组口服非诺贝特胶囊200mg／d。各组干预12周,干预前后采用ELISA法测定血清瘦素、IL-18、CRP、sICAM-1水平。另选20例健康体检者作为正常对照组。结果MS患者血清瘦素[（26．04±9．07）rig／mlVS（8．32±2．94）ng／ml,t=12．72,P〈0．01]、IL-18[（308．27±50．39）pg／mlVS（230．60±29．15）pg／ml,t=6．41,P〈0．01]、CRP[（2．65±0．57）ng／ml vs（1．26±0．23）ng／ml,t=9．69,P〈0．01]、sICAM-1[（331．89±60．08）ng／mlVS（246．43±39．32）ng／ml,t=5．98,P〈0．01]及HOMA—IR（4．38±2．06vs2．12±0．50,t=4．81,P〈0.01）等指标职显高于健康人。经12周运动干预后,MS患者瘦素[（26．38±10．85）ng／mlvs（19．63±6．27）ng／ml,t=2．22,P〈0．05]、IL-18[（309．40±49．77）pg／mlvs（291．80±39．21）pg／ml,t=2．33,P〈0．05]、CRP[（2．73±0．72）ng／mlvs（2．28±0．38）rig／ml,t=3．41,P〈0．01]及sICAM-1[（333．85±55．97）ng／ml V8（306．24±50．55）ng／ml,t=3．16,P〈0．01]水平及HOMA—IR（4．53±2．39V82．89±0．69,t=2．87,P〈0．01）明显下降。结论有氧运动是MS患者一种有效的治疗方法。运动治疗的作用机制可能与降低机体脂肪炎症因子水平,改善血管内皮功能,进一步改善胰岛素抵抗有关。     

短期强化生活方式干预对社区糖调节受损患者的影响

目的观察短期强化生活方式干预对社区糖调节受损患者代谢指标的影响。方法在山西省太原市迎泽区中随机选取糖调节受损患者90例,并随机分为干预组（n=45）和对照组（n=45）,对照组给予一般糖尿病健康知识讲座,干预组在此基础上,进行为期3个月的强化生活方式干预。比较干预前后干预组代谢指标,以及干预后干预组和对照组之间指标的差别。结果干预组干预后与干预前相比,口服葡萄糖耐量试验2h血糖（F=13．47,P〈0．05）及胰岛素抵抗指数显著降低（F=82．25,P〈0．05）;干预后干预组与对照组比较,体重指数（t=-2．44,P〈0．05）、收缩压（t=-3．39,P〈0．05）、舒张压（t=-3．97,P〈0．05）、空腹血糖（t=-3．89,P〈0．05）、口服葡萄糖耐量试验2h血糖（t=-7．22,P〈0．05）、总胆固醇（t=-2．72,P〈0．05）、低密度脂蛋白（t=-2．74,P〈0．05）、糖化血红蛋白（t=-3．73,P〈0．05）均明显降低。结论短期强化生活方式干预能显著改善社区糖调节受损患者的多项代谢指标,或延缓代谢指标的恶化进程,此生活方式干预策略适用于山西省太原市的社区居民。     

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.     

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.     

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.