重度妊高征终止妊娠时间及分娩方式的选择

目的:通过对重度妊高征的围产儿预后分析,探讨重度妊高征终止妊娠的时间及方式。方法:对120例重度妊高征进行回顾性分析研究,观察新生儿窒息率及死亡率。结果:36~36+6孕周组新生儿窒息率及围产儿死亡率均低于<36孕周和≥37孕周组。剖宫产组新生儿窒息率及围产儿死亡率明显低于阴道分娩组。结论:重高妊高征36~36+6孕周终止妊娠对围产儿影响最小,剖宫产是重度妊高征患者终止妊娠的主要措施。     

重度妊高征终止妊娠时机及分娩方式对围生儿结局的探讨

目的:探讨重度妊高征终止妊娠的时机和方式对母儿的影响。方法:对70例重度妊高征患者资料进行回顾性分析研究。观察新生儿的窒息率和死亡率。结果:该院70例重度妊高征经及时终止妊娠,选择适当的分娩方式,母亲全部存活。剖宫产率84.29%,新生儿窒息率27.14%,围生儿死亡率10.00%。≤32周分娩的新生儿窒息、围生儿死亡率明显升高(P<0.01),33~36周与≥37周无显著性差异(P>0.05)。结论:重度妊高征患者如病情需要,在促胎肺成熟治疗后可于孕32周终止妊娠,终止妊娠方式首选剖宫产。     

83例重度妊高征终止妊娠时间及方式的探讨

目的:探讨重度妊高征终止妊娠时间及分娩方式与母婴预后的关系,寻找减少围产儿死亡的对策。方法:对2005年83例重度妊高征进行回顾性分析,比较不同孕周及两种分娩方式对母婴预后的影响。结果:83例孕妇中围产儿90例,窒息率7.78%,死亡率66.70‰。孕34周前新生儿窒息率、死亡率较高,孕34周后明显下降,孕36周后最低。剖宫产组新生儿窒息率、产妇发生子痫、产后出血率明显低于阴道组。结论:重度妊高征36周终止妊娠既可避免病情恶化,又可提高围产儿存活率。剖宫产术是重度妊高征终止妊娠的最佳选择。     

重度妊高征合并胎儿生长受限围生儿的结局

目的:探讨重度妊高征合并胎儿生长受限(FGR)孕妇分娩时机与围生儿结局的关系。方法:选择145例重度妊高征合并FGR患者,按孕周大小共分6组,A组28～30-1周、B组30～32-1周、C组32～34-1周、D组34～36-1周、E组36～37-1周、F组37～39周,回顾分析其围生儿结局。结果:A、B、C3组的新生儿窒息、肺透明膜病、新生儿死亡发生率显著高于D、E两组(P0.01),而D、E两组与F组之间比较差异无显著性(P0.05)。F组的羊水Ⅲ度污染、胎儿窘迫发生率均显著高于D、E两组(P0.01)。结论:重度妊高征合并FGR患者分娩宜选择在孕34～37-1周。适时终止妊娠,对降低围生儿发病率和死亡率有重要意义。     

重度妊高征终止妊娠时间及方式的探讨--附180例临床分析

目的探讨重度妊高征终止妊娠时间及方式.方法以回顾性的方法对180例重度妊高征进行分析总结.结果180例中获取新生儿187例新生儿窒息率19.25%,围产儿死亡率5.88%,妊娠≥36周无一例新生儿死亡及重度窒息,且剖宫产术取得的围产儿预后良好.结论重度妊高征36孕周对围产儿影响最小,此时终止妊娠可避免病情恶化,又可提高围产儿成活率.而剖宫产术是重度妊高征终止妊娠的主要措施,但并非是唯一措施.     

重度妊高征终止妊娠时间及方式的探讨——附180例临床分析

目的 :探讨重度妊高征终止妊娠时间及方式。方法 :以回顾性的方法对 180例重度妊高征进行分析总结。结果 :180例中获取新生儿 187例新生儿窒息率 19.2 5 % ,围产儿死亡率 5 .88% ,妊娠≥ 36周无一例新生儿死亡及重度窒息 ,且剖宫产术取得的围产儿预后良好。结论 :重度妊高征 36孕周对围产儿影响最小 ,此时终止妊娠可避免病情恶化 ,又可提高围产儿成活率。而剖宫产术是重度妊高征终止妊娠的主要措施 ,但并非是唯一措施。     

重度子痫前期孕妇期待治疗后妊娠结局分析

目的探讨重度子痫前期孕妇期待治疗后对妊娠结局的影响。方法回顾性分析100例重度子痫前期孕妇的资料,孕周〈34周56例为A组,孕周34～36^＋6周44例为B组,对两组治疗后妊娠结局进行分析。结果A组低出生体重儿发生率（69．64％,39／56）明显高于B组（18．18％,8／44）,A组新生儿窒息率、转新生儿重症监护病房率和围生儿病死率均高于B组（P〈0．05）。结论重度子痫前期孕妇及时治疗,适时终止妊娠,尽量延长孕周（≥34周）,可改善围生儿预后。     

重度子痫前期孕妇期待治疗后妊娠结局分析

目的 探讨重度子痫前期孕妇期待治疗后对妊娠结局的影响.方法 回顾性分析100例重度子痫前期孕妇的资料,孕周＜34周56例为A组,孕周34～36+6周44例为B组,对两组治疗后妊娠结局进行分析.结果 A组低出生体重儿发生率(69.64%,39/56)明显高于B组(18.18%,8/44),A组新生儿窒息率、转新生儿重症监护病房率和围生儿病死率均高于B组(P＜0.05).结论 重度子痫前期孕妇及时治疗,适时终止妊娠,尽量延长孕周(≥34周),可改善围生儿预后.     

重度子痫前期及子痫终止妊娠时机和方式对围生儿结局的影响

目的 探讨重度子痫前期及子痫终止妊娠时机和方式对围生儿结局的影响。方法回顾性分析重度子痫前期90例、子痫10例患者的临床资料。按终止妊娠时的孕周将其分为三组：〈34周组（15例）、34～36撕周组（46例）、≥37周组（39例）。按终止妊娠的方式将其分为两组：剖宫产组（81例）和阴道产组（19例）。对比分析终止妊娠时机和方式与新生儿窒息及病死率的关系。结果〈34周组与34—36＋6周组、≥37周组新生儿窒息率分别为60．0％、21．7％、56．4％，围生儿病死率分别为13．3％、2．2％、5．1％，34～36撕周组新生儿窒息率及围生儿病死率最低。剖官产组新生儿窒息率和围生儿病死率（34．6％和3．7％）明显低于阴道产组（68．4％和10．5％），差异均有统计学意义（P〈0．05）。结论适时终止妊娠是治疗重度子痫前期和子痫有效的方法，34—36^＋6周为终止妊娠的最佳时机；终止妊娠的最佳方式为剖宫产。     

重度妊高征对围产儿不同出生情形预后影响

目的:了解重度妊高征不同的胎龄、分娩方式对围产儿预后的影响。方法:对2004年1月~2005年12月在该院分娩的98例诊断为重度妊高征的孕妇及其围产儿不同的出生情形进行观察分析。结果:共出生围产儿104例,出生窒息发生率9.62%(10/104),死亡率4.81%(5/104),其中孕周<34周17例,出生窒息发生率23.53%(4/17),死亡率17.65%(3/17);孕周≥34~35周11例,窒息发生率及死亡率均为"0";孕周≥36周以上76例,出生窒息7.89%(6/76),死亡率2.63%(2/76),3组比较有显著性差异。剖宫产出生67例,窒息7例,占10.45%,死亡2例,占4.48%,阴道分娩37例,窒息3例,占8.10%,死亡2例,占5.40%,两组比较无显著差异。结论:重度妊高征特别是孕周<34周者,应尽量延长胎龄,促胎肺成熟,在孕34~35周为适时终止妊娠时机,同时应加强产科、儿科配合,主张新生儿科医师进入产房、手术室监护,有望提高新生儿窒息抢救成功率及围产儿存活率。剖宫产是处理重度妊高征的主要方式,但并非是唯一方式。     

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.     

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.     

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.     

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.