我国婴儿早产部分危险因素的Meta分析

目的:综合评价早产与其危险因素的关联性。方法:应用Meta分析方法对已发表的10篇关于早产危险因素的病例对照研究文献进行综合分析,共累积病例1 257例,对照1 511例。根据齐性检验结果决定采用何种模型来计算OR及其95%可信区间,若同质选用固定效应模型,若不同质选用随机效应模型。结果:胎膜早破、妊高征、前置胎盘、多胎、胆淤症5个研究因素的合并OR及其95%可信区间分别为4.11(3.22,5.23)、3.14(1.45,6.79)、13.02(5.71,29.72)、3.94(1.91,8.11)和21.85(6.38,74.80)。结论:早产与胎膜早破、妊高征、前置胎盘、多胎、胆淤症有关。     

产后出血影响因素及临床护理对策

目的探讨产后出血的影响因素,提出针对性护理对策。方法选取2017年3月至2018年6月在我院住院分娩的产妇282例,分为干预组(产后出血, 22例)和常规组(未发生产后出血, 260例),收集两组产妇的一般临床资料和可疑危险因素,分析产后出血发生的影响因素,根据相关危险因素提出护理对策。结果单因素分析显示,年龄、妊娠合并高血压、妊娠合并糖尿病、剖宫产、前置胎盘、多胎妊娠在干预组和常规组中比较有统计学差异(P <0.05)。多因素分析显示,年龄(OR=2.341, 95%CI为1.214～12.214)、妊娠合并高血压(OR=3.221, 95%CI为1.315～15.214)、妊娠合并糖尿病(OR=3.654, 95%CI为1.614～15.999)、剖宫产(OR=1.947, 95%CI为1.051～11.301)、前置胎盘(OR=2.554, 95%CI为1.310～12.514)及多胎妊娠(OR=3.064, 95%CI为1.225～15.451)为影响产后出血的独立危险因素。结论影响产后出血危险因素较多,临床中针对相关危险因素实施护理对策对减少产后出血有重要的临床价值。     

早产危险因素meta分析

目的　综合分析中国早产发生的危险因素。方法　采用meta分析对国内 1994~2003年发表的有关早产危险因素的文献进行汇总、归纳和定量综合分析。结果　前置胎盘、产前出血、胎膜早破、多胎、臀位、妊高症、流产史、产前检查的合并OR值及其 95%C1分别为 7. 8781(5. 0103-12. 3876)、5. 4065(3. 009-8. 8552)、4. 4165(3. 2983-5. 9133)、4. 3601(2. 6414-7. 1973)、2. 7070(1. 8331~3. 9972)、2. 0432 (1. 3512-3. 0895)、1. 1651 (0. 7518 ~1. 8057)、0. 2946 (0. 2269 -0. 3824)。结论　前置胎盘、产前出血、胎膜早破、多胎、臀位、妊高症为早产的危险因素,流产史与早产的的关系尚不确定,产前检查为早产的保护因素。     

早产危险因素的1:2配对病例对照研究

目的探讨该地新生儿早产的可能危险因素,为新生儿早产的病因学研究提供科学依据。方法采用1∶2配对病例对照研究方法,选取2014年5月-11月期间在西安交通大学第一附属医院住院分娩的早产产妇130例和260名正常分娩产妇进行回顾性分析;采用单因素和多因素条件Logistic逐步回归进行新生儿早产危险因素分析。结果单因素χ2检验结果显示,从事体力劳动者、人工流产史、妊娠期高血压疾病、胎膜早破、前置胎盘、臀位与早产的发生有统计学关联(P0.05)。多因素条件Logistic回归分析显示,从事体力劳动者(OR=2.572,95%CI:1.071~6.174)、妊娠期高血压疾病(OR=29.704,95%CI:10.805~81.655)、胎膜早破(OR=5.774,95%CI:2.814~11.845)、前置胎盘(OR=42.228,95%CI:9.509~187.522)、臀位(OR=5.462,95%CI:1.772~16.839)是新生儿早产的危险因素。结论早产的危险因素是多方面的,需采取综合的防治措施。     

早产的高危因素及预防

目的:探讨早产的高危因素,以便采取有效预防措施。方法:回顾性分析58例早产资料,进行χ2检验。结果:58例早产中胎膜早破33例,感染20例,重度妊高征6例,双胎5例,羊水过多2例,前置胎盘2例,急性胰腺炎1例,臀位1例,纵隔子宫1例,原因不明11例。结论:胎膜早破及感染是导致早产的重要因素;重度妊高征,羊水过多,双胎,前置胎盘等也会导致早产;产前未行系统检查者早产率高。     

前置胎盘孕妇紧急剖宫产的预测因子分析

目的初步确定前置胎盘孕妇紧急剖宫产的预测因子,为产前护理和分娩择期提供临床依据。方法回顾性分析2007年4月-2017年3月医院收治的214例前置胎盘孕妇的临床资料,其中择期剖宫产121例,紧急剖宫产93例。单变量和多变量回归分析紧急剖宫产预测因子。结果医源性早产43例,单因素分析剖宫产史(OR 3.4;95%CI 1.64~7.1)、早产37周(OR 3.4;95%CI 1.3~9.2)、胎龄32周产前出血(OR 18;95%CI 6.5~50)、胎龄32周产前出血(OR 9.7;95%CI 3.4~27)、产前出血次数(OR 14;95%CI 5.4~37)、产前出血住院(1~7 d OR 6.5;95%CI 2.3~18,7 d OR 27;95%CI 9.8~77)、产前出血补剂(铁剂OR 2.4;95%CI 1.4~4.2,输血OR 12;95%CI 3.6~43)。多因素分析剖宫产史(OR 4.6;95%CI 1.8~11)、产前出血1次(OR 7.5;95%CI 2.5~23)、产前出血2次(OR 14;95%CI 4.3~47)、产前出血≥3次(OR 27;95%CI 8.3~90)及产前输血(OR 6.6;95%CI 1.8~24)。结论剖宫产史、产前出血次数及产前输血为前置胎盘紧急剖宫产预测因子,此类前置胎盘孕妇需个性化产前保健,适时实行保守治疗,减少医源性早产。     

早产危险因素的病例对照研究

目的 通过分析早产危险因素,探讨降低早产发生率的干预措施.方法 采用病例对照研究方法,对2009年6月～2009年9月广州市某助产机构分娩的133例早产产妇及随机选择的293例足月产妇进行问卷调查和病例摘录,采用卡方检验进行单因素分析筛选出早产危险因素;多因素非条件Logistic回归进一步筛选早产的主要危险因素.结果 产妇高龄、文化程度低、家庭收入低及孕期使用电脑、有生殖系统感染、阴道流血、孕期体重增长低是早产危险因素,产妇有家族早产史、死胎史、既往早产史、多胎妊娠、胎膜早破、胎盘异常、羊水异常及孕次多会增加早产的风险(P<0.05),使用溶剂洗手和孕期使用空调为早产的保护性因素(均P<0.05).多因素Logistic回归分析各危险因素结果显示:发生早产的OR分别为:双胎妊娠19.161(95%CI:5.734～64.030),胎膜早破10.208 (95%CI:5.316～19.603),死胎史5.839 (95%CI:1.503～22.681),胎盘异常4.571(95%CI:1.734～11.989),孕期阴道流血2.894 (95%CI:1.387～6.040);早产保护因素的OR为:家庭收入高0.672(95%CI:0.492～0.918),孕期体重增长较多0.550(95%CI:0.335～0.905).结论 产妇有双胎妊娠、胎膜早破、死胎史、胎盘异常、孕期阴道流血为早产的主要危险因素,加强孕期健康教育、改善经济状况以及重视围产保健,对减少早产的发生至关重要.     

我国低出生体质量儿危险因素的元分析

目的探讨我国低出生体质量儿发生的危险因素,为进一步完善我国孕期保健工作提供循证依据。方法系统检索国内公开发表的有关我国低出生体质量儿危险因素的文献,检索数据库包括中国知网、万方、维普等中文数据库,共检索到218篇文献。所纳入的研究文献采用Stata软件进行统计分析,计算合并OR(95%CI)值。结果最终共纳入文献20篇,元分析结果如下:影响我国低出生体质量儿发生的危险因素主要有:被动吸烟,合并OR值及95%CI为2.22(1.65,2.99);妊娠期高血压疾病,合并OR值及95%CI为2.87(2.14,3.85);孕期贫血,合并OR值及95%CI为2.21(1.69,2.89);孕期不良情绪,合并OR值及95%CI为2.89(2.02,4.13);多胎妊娠,合并OR值及95%C为4.07(1.86,8.89);孕期检查次数少(5次),合并OR值及95%CI为2.24(1.19,4.22);孕期体重增加偏少,合并OR值95%CI为2.71(1.95,3.78);早产,合并OR值及95%CI为10.52(3.05,36.29)。结论被动吸烟、孕期体重增加偏少、孕期检查次数少(5次)、妊娠期高血压疾病、贫血、孕期不良情绪、多胎妊娠、早产均是我国低出生体质量儿临床常见的主要危险因素。     

早产与母亲孕期因素的流行病学研究

采用统计学方法分析了广州市海珠区1998-1999年202例早产儿与母亲孕期各因素之间的关系,结果发现：产前检查次数少、胎膜早破、妊高征等因素可明显增加早产危险性,其估计比数比（OR）及95%可信区间（95%CI）分别为产检次数多、无胎膜早破、无妊高征的6.757倍（95%CI=4.000,11.364)、3.932倍（95%CI=1.766、8.756)、6.602倍（95%CI=1.327、32.851)。这些结果提示：要降低早产儿发生率,必须大力加强孕期保健及高危孕产妇管理,减少产科并发症的发生。     

前置胎盘患者产后出血的高危因素及预防措施

目的探讨前置胎盘患者产后出血的高危因素及预防措施。方法回顾分析青田县人民医院收治的187例符合入组标准的前置胎盘患者的临床病例资料,根据是否发生产后出血分为产后出血组73例和产后未出血组114例,比较两组患者年龄、妊娠次数、前置胎盘类型、并发胎盘粘连或植入、妊娠糖尿病、贫血、产前出血、胎儿体质量、剖宫产史、宫内感染、糖耐量受损差异,采用单因素分析及Logistic回归分析产后出血的高危因素。结果 187例前置胎盘患者中共有73例患者产后出血,产后出血率为39.03%。产后出血组和产后未出血组胎盘前置类型、并发胎盘粘连或植入比例、贫血状况、产前出血比例、剖宫产史比例差异有统计学意义(P0.05)。Logistic回归分析表明,胎盘前置类型(OR=16.527,95%CI=3.484~22.743)、并发胎盘粘连或植入(OR=4.123,95%CI=2.872~6.995)、贫血(OR=2.358,95%CI=1.067~5.307)、产前出血(OR=2.602,95%CI=1.329~5.178)、剖宫产史(OR=2.289,95%CI=1.278~3.949)均为产后出血的高危因素。结论前置胎盘患者产后出血率较高,其危险因素复杂、广泛,分娩前应全面综合性评估患者风险,及时发现产后出血高危因素,从多方面采取针对性防治措施来降低产后出血的发生。     

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.     

Assessing occupational and environmental exposure

Exposure assessment is a poorly understood component of the science of epidemiology. The relationship between exposure to chemicals and ill-health outcomes is often calculated using crude exposure measures such as ever/never exposed or duration. When investigating subtle effects, exposures need to be characterized much more fully in terms of intensity, frequency, duration and route. While occupational exposures tend to be much greater than those experienced from the wider environment there is a need to remember that, for many chemicals, exposure can occur occupationally, environmentally and through consumer use of products containing the material of interest. Inhalation exposure has generally been the traditional focus for most epidemiological investigations but there is now growing awareness of the importance of the dermal and ingested routes of contact and internalization. Quantification of the exposure also needs to be related to a biological mechanism of action and exposure metrics need to be selected accordingly. Occupational exposures can generally be measured using simple well-validated techniques. Environmental exposures require much more sensitive instruments and are more difficult to assess. Exposure modelling, particularly for the environmental fate of chemicals has undergone many recent developments and Monte Carlo techniques can be used to characterize model uncertainty and variability. This approach to exposure assessment can now be used in the setting of the wider environment and will enable a far better understanding of the relationship between exposure and disease.     

Mercury toxicity due to the smelting of placer gold recovered by mercury amalgam

A 19-year-old man developed tremor in both hands and fatigue after starting work at a placer gold mine where he was exposed to mercury-gold amalgam. Examination revealed an intention tremor, dysdiadochokinesis and mild rigidity. The 24-h urinary mercury concentration reached a peak of 715 nmol/l (143 ug/l) shortly before the clinical examination, after which he was removed from working in the gold room [Mercury No. Adverse Effect Level: 250 nmol/l (50 ug/l)]. On review 7 weeks later his tremor had almost resolved and the dysdiadochokinesis and rigidity had gone. The 24-h urinary mercury concentration had fallen to 160 nmol/l (32 ug/l). The principal exposure to mercury was considered to be the smelting of retorted gold with previously unrecognized residual mercury in it. The peak air concentration of mercury vapour during gold smelting was 0.533 mg/m3 (Mercury Vapour ACGIH TLV: 0.05 mg/m3 TWA). Several engineering and procedural controls were instituted. This episode occurred at another mine site, unrelated to Mount Isa Mines Limited.     

How Adults with Acquired Brain Damage Perceive Computer Training as a Rehabilitation Tool: A Focus-group Study

The aim of this study was to explore and describe how adult outpatients with acquired brain damage and referred to occupational therapy perceive computer training with the RehaCom programs, in order to evaluate the method of treatment as a tool in the rehabilitation of persons with cognitive disorders. By using focus-group discussions as a qualitative method of research when analysing the result, five themes with corresponding categories emerged, describing a development of understanding and learning about capacities. Themes describing how the participants could apply strategies to overcome shortcomings in daily occupations and the therapeutic role of the occupational therapist were identified as well. The result shows that a computer training program such as RehaCom can be used as an educational tool, for example, to guide a person who is trying to adopt compensatory strategies to avoid overload by taking pauses. It was found that anything the participants learned was also applicable to occupational performance in daily life.